What are Psychological Therapies?

The term 'psychological therapy' refers to a range of interventions to help people understand and make changes to their thinking, behaviour and relationships to relieve distress and to improve their functioning, well-being and quality of life. The most common psychological therapy modalities include cognitive behavioural therapy (CBT), psychodynamic psychotherapy, interpersonal therapy, arts therapies (including art, music and drama therapy), counselling, and family and couple therapy.

Psychological therapies are recognised as effective treatments for a wide range of mental health needs, with an increasing evidence base demonstrating the effectiveness and economic benefits of psychological interventions. The National Institute for Health and Clinical Excellence (NICE) recommends that psychological therapies be made available on the NHS as first-line interventions for a number of conditions.

Delivery of psychological therapies in the NHS may involve several different groups of staff, including clinical psychologists, nurse practitioners, psychotherapists and counsellors. In addition to staff directly employed by the NHS, psychological therapy may also be provided by therapists working for private, independent or voluntary sector organisations.

Staff may join the psychological therapies workforce from a range of different occupations and training routes. Some enter from specific training within the NHS, such as clinical psychology. Others may be trained in core professions such as nursing or psychiatry and then develop specific competencies in psychological therapy. Others may train directly in counselling or psychological therapies, often completely outside the NHS.

A number of economic and social factors may be increasing demand for psychological therapies:

The current economic climate, including unemployment, personal debt, home repossessions, offending and family breakdown may lead to a rise in mental health need. A survey for the mental health charity Mind (2010b) Workers turn to anti-depressants as recession takes its toll, found that since the last recession, one in ten workers sought support from their doctors and 7 per cent started taking antidepressants for stress. Additionally, their mental health needs were directly caused by the effects of the recession on their workplace. The findings, which launched Mind’s campaign Taking Care of Business, coincided with Government statistics showing the biggest rise in antidepressant prescriptions ever, with a record 39.1 million issued in 2009, up from 35.9 million in 20086.

Demographic changes – including the ageing population and the increasing longevity of those with long-term conditions and complex needs – may also increase demand for psychological therapies. According to the Office for National Statistics (ONS, 2010a), the population in England is estimated to increase from approximately 52.7 million in 2011 to 60.8 million in 2031, an increase of approximately 15 per cent. The ONS estimates that the number of people aged 65 and over is likely to increase from approximately 8.8 million in 2011 to 13.2 million in 2013, an increase of approximately 51 per cent. Traditionally, those aged 65 and over have been low users of psychological therapy services, despite evidence supporting their effectiveness. One of the objectives in Talking therapies: a four-year plan of action is to ensure appropriate access to psychological therapy for people over 65 to address the current significant under-representation of those in this age group in IAPT services.

Changing public attitudes and behaviour towards mental health, supported by campaigns such as Time to Change, and a reduction in the stigma associated with mental health issues could lead to people becoming more willing to seek help and access the services they need.

Access to work policies are increasingly being promoted. The aim is to improve social and economic participation by tackling unemployment, by encouraging and providing access to services, including psychological therapy, for those with mental health issues to assist them to gain employment or return to work.

The potential of innovation and information technology to transform mental health services – for example through the increasing exploration of online solutions and e-therapy – may also increase demand for psychological therapies.

Trauma and abuse are becoming recognised as a major cause of a range of mental health problems, including psychosis, depression, self-harm, substance misuse, eating disorder. It may complicate recovery so that those people with long term mental health problems, those who have longest hospital stays, are more risk, have more interpersonal problems, may have more severe trauma. National inquiries, e.g. Rotherham, are making it clear that statutory services need to be able to respond to survivors. One of their needs may be for psychological therapy.

Real Life Experience

If you'd like to share your experience of psychological therapies, please email tewv.vrc@nhs.net