So if CBT is not for you then what else is there?

CAT : Cognitive Analytical Therapy

Anxiety Management

Mood Management

Therapeutic Community (Complex needs service)

Counselling

Relationship and Family therapy

Group Analytical Therapy

Psychodynamic (psychoanalytic) psychotherapy

IPT : Interpersonal psychotherapy

Descriptions of these can be found on these websites:

NHS Choices information service : http://www.nhs.uk/Pages/HomePage.aspx

Healthy minds : http://www.healthymindsbucks.nhs.uk/

Complex needs Service : http://www.oxfordhealth.nhs.uk/?service_description=complex-needs-service

Oh boy that is rather a long list isn’t it!

And those are all on the NHS, however don’t be fooled into thinking they will all be available to you in your area, as with everything it will depend on whether your particular PCT has funding and trained staff to run them (more on this later). Interestingly many charity organisations and private options are available and these are often far more accessible, however they do come at a price.

So how do you choose?

Well really you don’t, you go for an assessment and they decide which ones might be the most appropriate and then they put it to you and you choose. The problem is that with only 1 ½ hour assessment it seems to be a very difficult job to get an accurate picture of what a person’s problems are and their ability to cope with a particular therapy.

We all have defence mechanisms, http://en.wikipedia.org/wiki/Defence_mechanism strategies unconsciously done to protect ourselves from emotional trauma and these will come to the fore when starting therapy to defend us from the problems we perceive as traumatic.  Every one has them but if you're having problems that have brought you to therapy then these mechanisms have produced maladaptive behaviours (http://en.wikipedia.org/wiki/Coping_(psychology) ), things that actively hurt us either physically or emotionally and these are the things we are trying to disengage from.

Problem is these are the very things we are not going to want to look at but will need to, to engage with the therapy and make improvements to our lives.

So the real question as to which therapy is the most suited is how defensive and maladaptive are we and which areas are we the worst about?

And that’s really what the assessment is about, finding out which and really it doesn’t take going into all our problems to do that. It takes going in to some of them and then using challenging language/ questions to see how we react.

Still a very tricky thing to do and given the number of options it seems fraught with problems.

The interesting thing is that even the most maladaptive person can appear quite healthy of mind on certain subjects, and/or for certain time spans and it isn’t until one of their hotspots/big problem areas are touched on that show their true depth of feeling and the behaviours that cause the problems in their lives. The sad fact is that if they don’t talk about them then they don’t show them and sadly they may have protected themselves so well that they won’t know what they are either.

The assessment seems a very crude measure for the problems that could be encountered and quite possibly a very poor one for some people. The more you have protected yourself the harder it is going be to open up and therefore give an accurate picture of their problems and therefore be given the most suitable therapy option.

Seems like an insurmountable problem?

A whole lot of hassle just to get put on a waiting list?

Pretty much I guess especially for those of us who don’t feel we really have a big problem, so why go through the hassle?

Because it is unlikely to get any better if you don’t and the sooner the better I would say too. There are no short cuts to knowing yourself nor sorting your problems and though you may take many wrong turnings it is the end goal that is really important.

I personally would like to see a more extensive assessment. One that would involve 2 meetings and the person going away with some information about the therapy or some questions/exercise to do/ think about and coming back to discuss them. That these be in line with the therapy that is being considered for them; for instance one of the CAT exercises, or further thought about their fears or particularly difficult times/emotions. I feel a need to see how the person deals with a little therapy situation before they commit to doing the therapy. This would not be fool proof nor give a 100% take up of the therapy but would give some indication for what is to come and give a more accurate assessment of whether a particular therapy is for them.

Ultimately though I feel the only way to know if a therapy is going to work for someone is to let them do it.