Mental Health Therapy Question

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Lydia Gwilt
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Mental Health Therapy Question

Post by Lydia Gwilt » Wed Oct 14, 2020 11:58 am

I know that several people here are or have been in close association with mental health providers in the UK and I wondered if anyone here can help to define what kinds of therapy might be useful under the following circumstances

A close-ish family member (call him A) in his late 40s seems to be having a nervous breakdown that is related to teenage trauma - his father died very unexpectedly when he was 13ish and his mother then brought him up alone - elder siblings having left home - but she was alcoholic and a seriously manipulative person. He has said that he remembers literally nothing from his teens except his brother's and then his sister's wedding. His father also had a nervous breakdown, which sounds similar to what A is undergoing.

His partner is trying to get him help but the local mental health people (he is in the UK) want him to define what kind of help he wants; and she really is lost here - she has heard of Talk Therapy and Cognitive Behavioural Therapy, but knows nothing about either or about anything else that might be of any use to him.

Any pointers about the pros or cons associated with either of these or any other therapies would be really helpful. Also are there any pharmaceutical options to just stabilise things while long-term options are being identified?

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discovolante
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Re: Mental Health Therapy Question

Post by discovolante » Wed Oct 14, 2020 12:54 pm

I have nothing useful to add as I am sure that they just want a practical solution atm rather than going to war with mental health services, but to put it mildly it seems a bit unreasonable to to suggest that someone with potentially complex trauma should be asked to 'choose their own therapy'.

If there is no way of pointing this out to them then maybe a mental healthy charity (national or local) might be able to help them understand the possible treatments available even if they can't advise on the most appropriate one, or see if there are any local advocacy services available?

ETA or orgs for survivors of abuse/trauma
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nezumi
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Re: Mental Health Therapy Question

Post by nezumi » Wed Oct 14, 2020 1:43 pm

I have recently been diagnosed with PTSD and I haven't started therapy yet, I've had psychotherapy, mixed approach and CBT in the past and they did precisely nothing. The latest type I've been recommended is EMDR which appears to have good evidence. Apparently it is quite difficult to find a good accredited practitioner though so buyer beware!

Lydia Gwilt
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Re: Mental Health Therapy Question

Post by Lydia Gwilt » Wed Oct 14, 2020 1:58 pm

THank you Discovolante and Nezumi, I shall pass that info on.

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discovolante
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Re: Mental Health Therapy Question

Post by discovolante » Wed Oct 14, 2020 2:26 pm

nezumi wrote:
Wed Oct 14, 2020 1:43 pm
I have recently been diagnosed with PTSD and I haven't started therapy yet, I've had psychotherapy, mixed approach and CBT in the past and they did precisely nothing. The latest type I've been recommended is EMDR which appears to have good evidence. Apparently it is quite difficult to find a good accredited practitioner though so buyer beware!
I learned about EMDR partly through work but mostly watching Russian Doll. Make of that what you will. (A commentary on me, not EMDR!)
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lpm
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Re: Mental Health Therapy Question

Post by lpm » Wed Oct 14, 2020 3:02 pm

EMDR is fascinating

- very good evidence that it works
- very little understanding of why it works

The way the brain processes memory is still a mystery, but dividing the brain's task into two - half concentrating on the movement and half recalling the memories - appears to reduce the intensity of the memories. And those less intense memories appear to get stored in the brain, overwriting the original intense memories.
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JellyandJackson
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Re: Mental Health Therapy Question

Post by JellyandJackson » Wed Oct 14, 2020 3:30 pm

discovolante wrote:
Wed Oct 14, 2020 12:54 pm
I have nothing useful to add as I am sure that they just want a practical solution atm rather than going to war with mental health services, but to put it mildly it seems a bit unreasonable to to suggest that someone with potentially complex trauma should be asked to 'choose their own therapy'.

If there is no way of pointing this out to them then maybe a mental healthy charity (national or local) might be able to help them understand the possible treatments available even if they can't advise on the most appropriate one, or see if there are any local advocacy services available?

ETA or orgs for survivors of abuse/trauma
I think your point about choosing your own therapy is spot on. My only experience here is on the receiving end of a group CBT programme for OCD. I knew a little about CBT and what services might be on offer, but I was still so scrambled by the time I got to the GP for help I needed a lot of support from her.

I second the contacting a charity to ask for guidance - MIND always seem to me to put out some good stuff, but as I say I’m far from the expert. My GP is excellent though I know not all are, and was able to describe what was available and what she thought would help.
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Re: Mental Health Therapy Question

Post by basementer » Wed Oct 14, 2020 3:32 pm

Regarding cognitive behavioural therapy: there are free online courses in CBT for anxiety and depression at www.justathought.co.nz which will give an idea of how it works. (Caveat: it's a NZ website, so the emergency contact details mentioned won't apply in other countries.)
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mediocrity511
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Re: Mental Health Therapy Question

Post by mediocrity511 » Wed Oct 14, 2020 7:05 pm

Are they literally meaning "well what treatment do you fancy then?" Or are they more wanting him to define what he wants from mental health services? Does he want to unpack the past or is his priority dealing with the here and now? Does he want therapy now (sometimes when people are too unwell, they can't effectively engage with it) or would he like support alongside potentially trying medication? Is he able to keep himself safe?

Therapies like CBT can be really helpful, but they don't much deal in the past and are much more focused on behaviours and thoughts. Psychotherapy can involve more unpicking the past. One of the most helpful things I did with a psychologist was narrative therapy, which involved trying to piece together a timeline of events using my memory and medical notes to try and understand a period of time that I didn't remember very well or in order.

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sTeamTraen
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Re: Mental Health Therapy Question

Post by sTeamTraen » Thu Oct 15, 2020 12:16 pm

Lydia Gwilt wrote:
Wed Oct 14, 2020 11:58 am
A close-ish family member (call him A) in his late 40s seems to be having a nervous breakdown that is related to teenage trauma - his father died very unexpectedly when he was 13ish and his mother then brought him up alone - elder siblings having left home - but she was alcoholic and a seriously manipulative person. He has said that he remembers literally nothing from his teens except his brother's and then his sister's wedding. His father also had a nervous breakdown, which sounds similar to what A is undergoing.

His partner is trying to get him help but the local mental health people (he is in the UK) want him to define what kind of help he wants; and she really is lost here - she has heard of Talk Therapy and Cognitive Behavioural Therapy, but knows nothing about either or about anything else that might be of any use to him.

Any pointers about the pros or cons associated with either of these or any other therapies would be really helpful. Also are there any pharmaceutical options to just stabilise things while long-term options are being identified?
I'm a non-clinical psychologist, but I hope I have some understanding of how the field works.

A model that I find useful is that there are basically three tracks of MH provision:
- Psychiatrists (medical doctors with specific training in mental disorders)
- Psychologists (non-medical people with scientific training)
- Psychotherapists (people with training and experience that ranges from outstanding to nil)

Very very roughly, you would go to a psychiatrist for a psychotic condition (schizophrenia, personality disorders, etc), a psychologist for a neurotic condition (OCD, anxiety, etc), and a psychotherapist for things that are causing you anguish (past trauma, etc). This is an incredibly simplified version of things, though. First, many practitioners have training (and [verb] practise) across all of those areas, and second, things are very rarely anything like as simple as that (for example, the whole "psychosis/neurosis" divide dates back to Freud and is just a convenient shortcut that is sometimes useful).

You could add a fourth level: A sympathetic GP. They may not have much time to deliver talking therapy, but along with the psychiatrists, they are the only ones who can prescribe any sort of drugs.

Psychological and psychiatric interventions are available on the NHS, if you can find them with a waiting time that you're prepared to put up with. Psychotherapists are typically private; some private medical insurance policies will cover them.

Because anyone can put "psychotherapist" on a brass plate outside their door, it's important to choose a therapist who is registered with the British Association of Counselling and Psychotherapy (BACP). (Some sources draw a distinction between "counselling" and "psychotherapy", others don't. Originally, "counselling" was just a word made up by Carl Rogers because the Freudians wouldn't let him call himself a psychotherapist.)

Based on what you've written, my tentative suggestion would be for A to see his GP about the possibility of medication, and then look for a psychotherapist who specialises in family trauma. Of course, it's possible that there is a different cause, or even a neurological problem, and that he (or someone else?) is ascribing his current state to the past trauma. A good psychotherapist will be alert to these possibilities.

The BACP web site has a "Find a therapist" function. I also have a few contacts in the UK community and might be able to find at least someone who can vouch for a person in your area; you can DM me if you want.
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Lydia Gwilt
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Re: Mental Health Therapy Question

Post by Lydia Gwilt » Thu Oct 15, 2020 12:39 pm

THank you all very much for your time and information. I am passing it all on to the family member who is interacting directly with A's partner (they live in the same town).

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Stephanie
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Re: Mental Health Therapy Question

Post by Stephanie » Fri Oct 16, 2020 6:02 pm

As far as I'm aware, in terms of services via the NHS, and depending on what the symptoms are, most GPs will tend to go via IAPT initially. I've done both the phone counselling and face to face CBT stuff for a number of sessions.

IAPT manual states that they treat: depression, generalised anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, OCD, specific phobias, PTSD, health anxiety, body dysmorphic disorder, mixed anxiety and depressive disorder, irritable bowel syndrome, chronic fatigue syndrome and MUS not otherwise specified.

Brief paragraph of the some of the types of therapy they offer:
IAPT services offer a range of NICE-recommended therapies for depression and anxiety disorders in line with a stepped-care model, when appropriately indicated. Low-intensity interventions (guided self-help, computerised CBT and group-based physical activity programmes) have been identified as being effective for sub-threshold depressive symptoms and mild to moderate depression, as well as some anxiety disorders. For people with persistent sub-threshold depressive symptoms or mild to moderate depression who have not benefited from a low-intensity intervention, NICE recommendations include the following high-intensity psychological interventions: CBT, interpersonal psychotherapy (IPT), behavioural activation, couple therapy for depression, brief psychodynamic therapy and counselling for depression. For moderate to severe depression, high-intensity interventions recommended by NICE include CBT and IPT. Various forms of specialised CBTs are the NICE-recommended high-intensity treatments for specific anxiety disorders.
But lots more detail in the manual here, including some tables that list the specific therapies for each disorder, and explain what some of them are.

Good luck to your family member though, I hope they can find some suitable help.
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Lydia Gwilt
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Re: Mental Health Therapy Question

Post by Lydia Gwilt » Sat Oct 17, 2020 11:56 am

THank you Stephanie.

It looks as though he is able to get out of the house with his partner to walk the dogs, which is an improvement

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Re: Mental Health Therapy Question

Post by individualmember » Sat Oct 17, 2020 7:59 pm

My only experience is as a patient, I’m not in a position to advise what might be suitable for anyone else. I had a good experience with CBT, which seemed to me to be a menu of possibilities. My CBT chap taught me two techniques. The first was a mindfulness exercise which I still do sometimes. Then I did dream rescripting, which was remarkably successful at dealing with my recurring nightmares. I do have the skills to make myself a fairly elaborate recording that I would listen to on headphones when I went to bed, which other people might not be able to achieve. I suspect that the success or otherwise of CBT may be in the therapist matching the right techniques to the patient. I don’t know whether my personal anecdote helps or not, but there it is.

ETA, I got my therapist through Healthy Minds and I had a waiting period of about four months, ymmv.

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