How many sessions will I need?
To an extent it can vary, given that no-two-people will see the same thing, the same way.
That said, CBT is a highly-researched form of psychotherapy that is currently recommended by N.I.C.E (the National Institute of Clinical Evidence) as the leading psychological treatment for an increasing number of clinical presentations. This has led to the development of a number of standardised treatment protocols for treatment of emotional disorders including Panic Disorder; PTSD and OCD to name a few. As a CBT therapist I use these as a template to deliver treatment. These protocols are structured and can offer an approximate time-frame in terms of the number of sessions required.
To provide some examples, the treatment protocol for panic disorder recommends between 7-14 sessions (NICE; CG113 Jan 2011).
Trauma presentations require a minimum of 8-10 sessions although can vary depending upon whether isolated or multiple events have occurred.
OCD presentations will require a minimum of 10 sessions (NICE; CG31; Nov 2005) whilst I have found, often require double-this in practice, depending upon the severity of symptoms and impact on lifestyle.
If you would like to access further information, full details of N.I.C.E Clinical Guidelines can be found at www.nice.org.uk
When will I start to feel better?
Again, to an extent, this will vary depending upon the person and the presentation. The emphasis of the initial treatment phase is usually one of assessment rather than on treatment. It is common for clients to report an initial increase in their symptoms and/or distress levels, prior to clinical improvements. For many clients experiencing anxiety, engaging in CBT requires them to “face the fear” and talk about their problems (thereby activating their anxiety), that until that point they may have been very invested in avoiding. Although this can feel daunting initially, learning how to tolerate the emotion by “being with it” in a containing environment in the early sessions can prove hugely-empowering for clients as they begin to gain important new counter-evidence that they can cope, and tolerate their unwanted or undesirable emotion.
For others, gaining confidence and skill in the use of CBT techniques can take time to master before these amended coping responses “feel familiar” as the client’s new amended response. Learning any new skill can take time and requires repeated practice for us to feel accomplished. Many of us will have learnt to ride a bike; to swim, or drive and I am sure that these processes will not have come easily, or without a bump or two along the way? The therapy process is much the same.
Do I have to take medication in order to do therapy?
No. It is your choice, and one that I would respect. I am not medically-trained and would always actively-encourage you to start a dialogue with your GP to consider your specific medical history; your clinical symptoms and the NICE guidelines so that you can arrive at an informed decision that works for you.
There are certain instances (specific clinical presentation; severity of symptoms; associated distress) where a specific NICE guideline recommends a combined psychological and pharmacological treatment approach as the gold standard for achieving recovery. This recommendation will always be based on the research findings surrounding that particular clinical presentation.
It is important to acknowledge that CBT treatment will require you to access the emotion(s) that you are finding difficult. This is an essential part of processing the wider context within which it presents, and develop coping skills for self-management. We need to look backwards in order to move forwards. The therapeutic window of tolerance – our capacity to be able to sit with emotion – will vary from person to person. For some clients, their distress levels can be so considerable, that being able to connect with the associated material, particularly in the early treatment stages can prove too intense. Medication can therefore play an integral role in the regulation of our emotion, and can increase our tolerance to our emotion. Further information can also be found under the Managing Distress tab.
Is everything I tell you confidential?
Yes. There are three caveats to this. All of these relate to risk. My duty of care as a therapist although primarily-focused to you as my client, does also extend to the welfare of any child under the age of 18; any adult deemed to be vulnerable and also to the wider general public – particularly with regards to the threat of terrorism, racism and extremist or inciting extremist or violent behaviour.
In the event that you were to disclose information that led us to be concerned for your own immediate welfare; the welfare of a child or vulnerable adult, or the potential welfare of the public, we would have a clear and collaborative discussion about what information would need to be shared; to which agencies; by whom, when. I will never breach confidentiality without firstly gaining your permission to do so.
Further information regarding the British Association of Behavioural and Cognitive Psychotherapists (BABCP) Code of Ethics and Professional Standards of Conduct that I adhere to can be accessed from their website www.babcp.com
What do you do with my information?
I work transparently and believe strongly that the in-session therapy notes that we complete, including any I write in addition to exercises I invite you to complete, should be your property.
In accordance with the standards outlined by the BABCP, I am required to access regular clinical supervision with an accredited CBT supervisor to demonstrate that I am practicing in line with the current evidence-based clinical research. I am consequently required to provide documented evidence of these sessions for the BABCP, which are always anonymised; salient to the therapeutic processes and stored electronically via encrypted software. I am more than happy to answer any specific questions regarding this important aspect, at any point throughout the therapy process
Why do you ask me about what I do to help me cope?
Many of the clients that I see will acknowledge a degree of suicidal ideation (thoughts or images about suicide.) The majority of these clients would identify these experiences as “passive” in content; i.e. from a clinical perspective, identifying troublesome thoughts or images in the absence of any associated plan, method or active preparations in line with these thoughts. Therapy sessions would therefore manage these items, monitoring carefully, working with them using a positive-risk-taking formula. A further proportion of clients will have a risk history; one that might include previous suicide attempts or occasions of Deliberate Acts of Self Harm and/or of significant neglect. Some clients may also identify current risks. In order to help you to help yourself, It is imperative that you share all information related to your risk and vulnerability items. The best predictor of future behaviour is past behaviour. This is grounded in evidence-base; gained from multiple research trials, across a variety of clinical settings; age groups; genders and populations. The information you supply is necessary in helping us make predictions about the types of unhelpful coping behaviours that you could find yourself drawn to if therapy sessions were to activate your distress levels too considerably, without sufficient stabilisation and grounding techniques in place. The more information and detail I have, the more equipped I then am, both in monitoring your progress and in terms of the techniques and strategies I offer you to self-help. The Managing Distress tab provides further expansion on this aspect.
Can I access more than one therapy at a time?
I would generally advise against this. Accessing different therapeutic modalities simultaneously would likely offer conflicting approaches, causing confusion and replication of material. A potential worst-case-scenario could be destabilisation, which could be possible if neither therapist were aware of the others’ approach or treatment focus.
There is an exception to this however:
I would never turn anyone away who has had contact with their local NHS service provider, for they have a lot to offer. Establishing the nature and extent of involvement with your NHS provider, particularly in terms of whether accessing an assessment only, and/or whether current treatment is being, or due to be accessed, would be something we would need to identify. I would be happy to discuss this as part of our free telephone consultation.