Counselling Articles & News

What is Mindfulness Based Cognitive Therapy, what are its benefits, and who is it suitable for?

Mindfulness- Based Cognitive Therapy (MBCT) is a relatively new form of therapy that takes features from both mindfulness techniques and cognitive therapy.

Mindfulness can be described as being in the present moment and being aware of one’s body, thoughts, surroundings and feelings. It has roots in Buddhist traditions and has increasingly been adapted for use in therapy. Mindfulness can increase concentration levels,
and can help both mental and physical conditions including obsessive compulsive disorders, anxiety, and prevention of relapse in depression and drug addiction.
Mindfulness involves regulating attention so focus is held on the present moment and what is being experienced at the immediate time, so thoughts can be recognised rather than ignored. Instead of trying to get rid of thoughts they should be allowed to drift through your mind.

Cognitive therapy aims to identify unhelpful and dysfunctional thinking patterns, behaviours and emotional responses, and change them to overcome difficulties.
Patients are helped to develop skills to identify distortions in thinking, change and modify their beliefs and change their behaviours and the way they relate to others.
The therapist helps the client test out negative beliefs with the intention of disproving them and therefore decreasing their power. Testing assumptions that a client holds and questioning thoughts can show how they are unrealistic and unhelpful.
Once thinking patterns are tested and challenged it is easier to change the feelings associated with them.

Mindfulness based cognitive therapy combines the best aspects from both these theories.
MBCT focuses on accepting thoughts and feelings without judgement, rather than trying to push them of consciousness. This makes it easier to recognise and correct cognitive distortions.

Where does it originate from?
Jon Zabat-Zinn developed a programme of mindfulness based stress reduction
which was found to make a significant positive improvement in participants’ ability to deal with anxiety, stress and chronic pain. This original programme has been adapted for use with major depressive disorders, to help people who have been repeatedly depressed stay well.

What is the aim of MBCT?
The aim is to be less likely to be drawn into automatic reactions to thoughts, feelings and events. Being able to respond rather than react means the likelihood of getting upset or flying off the handle is reduced. Working on increasing awareness means a situation will be considered before it is responded to. This helps decide the most appropriate reaction.

Another area of focus consists of tackling emotional barriers and the tendency to behave on automatic pilot. Being aware of breathing and staying in the present is also covered. An emphasis is also placed on the best ways a client can look after themselves when depression threatens to strike. As with standard cognitive behavioural therapy, a big benefit of this form of therapy is that it teaches techniques that can be used in future situations.

A strong message of MBCT is that thoughts are not facts. The aim is to allow negative moods, sensations and thoughts to drift through without having to battle against them, through staying in touch with the present moment. Accepting that just because you’re thinking it does not make it true can help you to stop fighting thoughts and accept them, at which point their validity can be considered. The priority is to learn how to pay attention and concentrate on each moment without judgement, and recognising that holding onto feelings is unhelpful and destructive.

What will it consist of?
Sessions may consist of classes and having assignments to do outside of classes. Mindfulness based cognitive therapy does take work, and it can be challenging. Clients will need to be committed and willing to do home assignments.

Who is it suitable for?
The UK National Institute of Clinical Excellence (NICE) recommends MBCT for patients that have suffered from three or more major episodes of depression.

A study conducted in Toronto, Cambridge and Bangor, participants who had had at least two major depressive episodes in their past either received treatment as usual, or treatment as usual and eight sessions of MBCT. The results showed MBCT most helped participants how had suffered multiple previous episodes. It had no effect on those that had only had two episodes. Those participants that had three of more previous episodes of depression experienced a substantially reduced risk of relapse. These findings were replicated by Ma and Teasdale in Cambridge, with relapse rate reduced from 78% to 36% in those who had experienced three episodes of depression or more.

What will you gain from MBCT?
Through mindfulness based cognitive therapy clients will learn to be more familiar with how their mind works and the patterns it follows. This will make it easier to recognise old habits that may reoccur and start a downward spiral. There is an association in the brain between negative thinking and depressive symptoms, and MBCT can help stop this link from triggering a depressive episode. By exploring more helpful alternatives to these old habits can allow a higher level of awareness of the world around you, rather than living in your own heads.
It can mean that instead of wishing things were different all the time, or beating yourself up for not meeting impossible goals, you can start noticing small pleasures and beauties that make life worth living.
It is possible to develop a way of thinking that doesn’t include battling with yourself and judging yourself all the time.

Benefits of mindfulness
Mindfulness can help reduce stress and increase positive emotions.
Stress reducing benefits

Stress produces emotional and physiological changes in the human which have evolved to increase chances of survival. However in a modern society, the threats are not the same as they were, but our bodies still react the same way. This stress can have a negative effect on mental and physical health, happiness and well being.

Studies have found that mindfulness specifically reduces distracting, negative and ruminating thoughts and behaviour (Jain and Shapiro, 2007). Focused breathing helps regulate emotions and reduce negative reactions to stimuli (Arch, 2006), and mindfulness results in reduced mood disturbance and stress (Brown, 2003) Practicing mindfulness also reduces stress, possibly because it helps re-assess what counts as a stressor – things initially seen as stressors may be relabelled after being considered (Garland 2009).

Mood enhancing benefits
Extensive research shows mindfulness can increase and sustain positive emotional states.
Fredrickson (2008) showed daily mindfulness exercises increase positive emotions and feelings of purpose in life and decrease illness symptoms. Davidson (2009) showed mindfulness can increase brain and immune system functions. Shao (2009) showed mindfulness develops part of the brain associated with a decrease in anxiety, along with an increase in positivity and immune function. In a randomized controlled study, he also showed mindfulness correlates with increased academic performance in MBA students!

Limitations of mindfulness based cognitive therapy
As stated earlier, research shows that MBCT has no effect on people who have experienced two or less episodes of depression. Other forms of therapy may be more helpful in those circumstances.

For more information on Mindfulness Based Cognitive Therapy visit

http://www.mbct.co.uk/

or

http://www.london-meditation.co.uk/about-mbct_mindfulness_based_cognitive_therapy.php

University of Oxford Centre of Suicide Research website

http://cebmh.warne.ox.ac.uk/csr/mbct.html

By Emma Bender

Therapists at Harley Therapy offer Mindfulness Based Cognitive Therapy (MBCT) in Harley Street and City of London.

Should vulnerable people be more protected from the potentially harmful effects of taking part in Britain’s Got Talent? Some leading mental health professionals argue they should.

Mental health charities including the Mental Health Foundation and British Association of Counsellors and Psychotherapists are warning that the selection process and format of television show Britain’s Got Talent can be a serious risk to contestants’ mental health and could even result in suicide. Simon Cowell and ITV have been urged to seriously re evaluate who they select to go through to live arena auditions.

As anyone who has watched the show can testify, both the best and worst quality acts go through to arena auditions in front of a live audience, who can then boo or cheer during their act whilst the judges decided whether to buzz to end the performance.

After a 60 year old man who had informed producers he had a history of severe mental health problems appeared in this section on the show, mental health charities have warned a tragedy following a negative reaction on the show is “inevitable”.

After Susan Boyle suffered a break down after the 2009 final, extra measures have been introduced this year including contestants being screened by a psychologist and being questioned on medical history.
Alyn James made producers aware that he had been sectioned and placed into secure psychiatric units seven times after being judged at risk of suicide, and used to be on enough prescription drugs to make “Pete Doherty look tame.”

Yet he was deemed to not be at risk, and chosen to appear on the televised arena auditions section of the show where he was booed and jeered at, in front of Simon Cowell, Piers Morgan and Amanda Holden. The crowd chanted “off, off, off” during his performance and howled with laughter. Amanda Holden described his song, which he wrote when he heard a friend had committed suicide, as “ever so depressing” He now believes he was selected with the expectation that he would be ridiculed.
James said: “I think they have the best and the worst on, and I was there to be the worst. I was like that old man who break-danced last year. I was invited on to be laughed at and ridiculed.”
Talkback Thames, who produce the show, defend the selection process by saying anyone has the right to enter and they aim purely to “reflect the broad range of people who put themselves forward”.

However, Philip Hodson, spokesman for the British Association of Counselling and Psychotherapy, argues that participants do not realise they are consenting to being “laughed at and ridiculed”.
James says he had no idea, before performing, that he might receive such a negative reaction, “But there I was looking like a complete and utter idiot.”
Hodson says this reflects a lack of informed consent, as participants of the show are not fully aware of what they might encounter.

Head of Mental Health Foundation Andrew McCulloch shares concerns and says the experience James suffered had highlighted serious issues and questions that need to be addressed. He emphasises the fact that subjecting vulnerable people to humiliation crosses all ethical boundaries and says he “fears the worst”.

Most people would agree the protection of vulnerable people should be more important than making an entertainment show. In James’ case warnings of health professionals seem to have rung true, as he has been in crisis care after his experience at the audition and is now judged to be a suicide risk. Watching bad acts may be “part of the fun” of the show but when it has consequences as serious as these, a changing of procedure may be necessary to prevent further damage to individuals self esteem and mental health.

An article in the Observer about this topic can be viewed at

http://www.guardian.co.uk/tv-and-radio/2010/may/30/britains-got-talent-suicide-fear

A video of Alyn’s appearance on the show can be viewed at http://www.dailymail.co.uk/news/article-1282624/Britains-Got-Talent-end-suicide-ridicule-continues-warn-mental-health-experts.html

By Emma Bender

Harley Therapy is a team of psychologists, counsellors, psychotherapists and psychiatrists to help with mental health issues. Click here to Find a London Psychologist

After the shock of the events in Cumbria this week, the local Samaritans area branch is opening an extra drop in centre to help provide support. The NHS is also offering drop sessions at the local hospital, with people in more remote areas being supported by mobile units run by the British Red Cross. There is also concern for ambulance staff who attended the crime scenes and counselling is being offered to all staff involved.

The need to talk through feelings about what has happened is recognised not only by health professionals but also by organisations in the local community. In the village of Seascale, where three members of the community lost their lives, a local youth project has been acting as an informal counselling service, offering “a cup of tea and a chat”. Locals are using it to talk about the events and some pub landlords are offering free tea and coffee in a bid to help locals gather and help each other work through feelings of shock and loss.

There is also concern for young people in the area, many of whom also have the added pressure of upcoming exams. Counsellors and educational psychologists will be available in schools to help support children and young adults who have been affected by the shootings, especially as some children witnessed the rampage. Two young girls who witnessed a shooting were deeply traumatised and could not speak for two hours after the incident.

Educational psychologists are concerned about post traumatic stress disorder affecting people in the area, including children. Dr Mark Hoelterhoff, who is an expert in PTSD, is working with Cumbrian police and is concerned people may suffer flashbacks, nightmares, and feelings of being unable to understand why some peoples’ lives were taken whilst their lives were spared. These feelings may be especially strong due to the apparently random nature of the acts of violence.

Post traumatic stress disorder can affect anybody who has experienced a harrowing incident, or knows somebody who has. (Royal College of Psychiatrists). Continuing with as normal a routine as possible, eating and exercising regularly and going back to work can help ease PTSD.

However, if symptoms do not start to ease after 6 weeks, it may be necessary to talk to a doctor about it. Counsellors and therapists can help by provide someone to talk to and process feelings.

It can be hard to talk to close family members who may also be affected, so talking to a counsellor can help by working through traumatic events with someone who is not so closely affected by the incident, and can offer non judgemental help. Therapy can also help tackle symptoms such as nightmares and flashbacks, and depression and anxiety that may accompany these. Counsellors can also help develop situation specific coping strategies to deal with the effects of traumatic incidents.

Treatment of post traumatic stress disorder is usually very successful so if an individual has developed symptoms, talking to someone they trust is important as bottling up feelings won’t help. Family or friends may try and avoid the subject so they do not have to think about unpleasant experiences, so a doctor or a counsellor may be easier to talk to.

To learn more about therapists at Harley Therapy who specialise in Post Traumatic Stress Disorder Counselling in London, go to http://www.harleytherapy.co.uk/trauma-counselling-london.htm

Victim support offer their Supportline to anyone who feels affected by any traumatic incident on 0845 30 30 900.

A comprehensive factsheet about PTSD is available at http://www.rcpsych.ac.uk/mentalhealthinfo/problems/ptsd/posttraumaticstressdisorder.aspx

The Guardian article about counselling provisions in the wake of the incident is available at http://www.guardian.co.uk/uk/2010/jun/04/cumbria-shootings-counselling-shock

Article by Emma Bender

In our press release on the 24^th of March, “Cognitive Behavioural Therapy on the Rise at Harley Therapy, London” showed how enquiries about Cognitive Behaviour Therapy (CBT) are increasing. Therapists practicing at Harley Therapy offer a wide variety of approaches, but they have seen a particular increase in interest in Cognitive Behaviour Therapy since 2006. As Clinical Director of Harley Therapy, Sheri Jacobson wrote about how the increase in popularity of Cognitive Behavioural Therapy may partly be due to the government’s endorsement within the IAPT (Improving Access to Psychological Therapies) initiative, which has generated publicity for the approach. Furthermore, individuals experiencing positive results when trying the therapy spread the word to their friends and family. The fact that CBT produces results a lot faster than other therapies also plays a part in its increasing popularity. The article stated how CBT is more easily quantifiable than other therapies, which makes it easier to prove its’ effectiveness, and looked at the process CBT uses to bring about positive change.  So why is Cognitive Behavioural Therapy becoming so popular with people seeking help on a variety of issues? What are the potential limitations of this form of therapy, and is it suitable for everyone?

Factors affecting the increase in popularity of Cognitive Behavioural Therapy

Accessibility

A major factor of the popularity of Cognitive Behavioural Therapy is its accessibility.

There has been a big increase in the number of CBT therapists available on the NHS – in 2007, the government earmarked £173m to train an extra 3,600 therapists in the approach by 2010 (figures from The Independent, link at the end of the article) Furthermore, following the trend there has been an increase in health insurance providers who cover talking therapy as part of their healthcare policies. Some therapists at Harley Therapy accept clients covered by their health insurance. These combined factors mean that CBT is more readily available to people seeking therapy. In addition to this, Cognitive Behavioural Therapy can produce relatively rapid results, which mean it may be more affordable than more traditional time-intensive therapies. In an easy to read book Brilliant Cognitive Behavioural Therapy, Dr Stephen Briers writes on how the underlying principles of CBT can be mastered relatively quickly, meaning courses of therapy following the CBT model can be time limited and equip people with skills with in a few months (full reference below). David Clarke, Professor of Psychology and Director of the Centre for Anxiety Disorders and Trauma at Maudsley Hospital, says depending on the issue being worked through, a course of Cognitive Behavioural Therapy could last between six and twenty sessions.

Secondly, to use a different meaning of the word accessibility, the principles of Cognitive Behavioural Therapy are more easily understood than more complex theories, and are therefore relatively easy to learn. This helps empower the client who is undertaking the therapy.

Skills-based approach

Linked to this idea of empowerment is the fact that CBT is skills-based and takes an educational approach. It consists of being introduced to techniques that can be used to tackle issues such as negative thinking, and practising using them, with the facilitation and assistance of the therapist. It may involve “home work” of exercises to do at home, such as making a log of feelings. The focus is on a client learning skills needed for them to tackle their own problems, and solve problems on their own. These techniques, once learnt, can be used in the future and are useful when other issues come up. This means the therapists’ role is to help equip clients with skills and help them practice these, rather than be an expert that “fixes” problem. Therefore some people will find this approach less threatening, and also reduces the risk of emotional dependence upon a therapist.

Research evidence

Another important factor is CBTs recent unprecedented track record of research indicating its effectiveness. In the last press release it was mentioned that the standardised measures used in CBT meant it was more quantifiable, and usefulness could be measured more easily. The National Service framework, used by the NHS, classifies the quality of evidence that is used in support of effectiveness. Research into Cognitive Behavioural therapy has been classified “level 1” evidence, which means at least one randomised controlled trial and one good systematic review has been undertaken with positive and significant findings (cited in an article by Jeremy Holmes, 2001, link below). However it is worth highlighting other therapeutic approaches also received honourable mentions.

A thorough study into “What Works For Whom?” conducted by Roth & Fonagy, 2005, showed that there is a body of methodologically sound research studies that provide strong evidence Cognitive Behavioural therapy is helpful in treating major depressive disorders, social phobias, generalised anxiety disorders, panic disorders, post-traumatic stress disorder, bulimia, and some of the behavioural problems that autistic children may experience. There is also some evidence to suggest is can be useful in treating bipolar disorder, obsessive compulsive disorders, anorexia nervosa, cocaine abuse and sexual problems. (cited in Brilliant Cognitive Behavioural Therapy, Dr Stephen Briers, 2009)

Therapy has also be reported to be as effective as anti-depressants for many types of depression by the Royal College of Psychiatrists, which makes it an attractive choice for people who may not want to use conventional drug treatments (website address below). In the Independent, the National Institute for Health and Clinical Excellence (NICE) recommends CBT should be the first approach treatment for mild and moderate depression, followed by drug treatment only if it is unsuccessful in producing positive change .

Quantifying improvements

Cognitive Behavioural Therapy seeks to measure the gains clients benefit from in observable and concrete terms. For example, during CBT, clients may be asked to frequently rate the intensity and occurrences of negative thoughts. A person experiencing anxiety may be asked to gauge the intensity of the anxious feelings from 1 to 10, whilst thinking about a situation that makes them nervous. If, during or after a course of CBT, they repeat the exercise and rate their level of negative feelings lower, this is a reasonably quantifiable, albeit subjective, demonstration that the client feels they have undergone positive change. This means it is possible to look at improvements made through CBT in measurable and more scientific terms than it is in other forms of therapy.

The need for careful assessment of most suitable therapeutic approach

However Cognitive Behavioural Therapy will not suit everyone, and its’ increasing popularity may mean conventional therapies that may be more useful for a particular person are overlooked. Another type of talking therapy may be more helpful to an individual than CBT. For this reason, assessment therapists should be able to discuss which approach they feel would be most beneficial.

Limitations of CBT

Although CBT produces faster results than some conventional therapies, it is not a “quick fix” and requires effort and commitment. When an individual is feeling low, it may be harder than usual to summon the energy and concentration to work on the exercises. Furthermore, to overcome anxiety and negative thinking patterns, it is necessary to confront them and work through them. This may be very hard in the beginning if individuals have spent years trying to suppress or ignore these feelings. Confronting these feelings may create more anxiety in the short term.

Severe depression, CBT and medication

Furthermore, Cognitive Behavioural Therapy cannot take the place of medication, if it is necessary. Depression can have psychological, physical and social symptoms, and can interfere with everyday work, social and family life. Mild and moderate depression may make daily life seem hard to cope with and seem less worthwhile, and have a significant impact on your daily life.  However, if you have a lack of interest in doing anything at all which makes daily activities almost impossible, or physical symptoms such as excessive tiredness or loss of appetite, you may be suffering from severe depression. For people suffering severe depression, a medical diagnosis may be needed to determine whether medication is necessary. A visit to a GP could be a first step. Psychiatrists at Harley Therapy can offer diagnostic evaluations and treatment programmes if needed. There are different types of antidepressant treatments available and a psychiatrist can help determine which one may be most appropriate. All have side effects, so it’s important to get as much information possible about it to make sure to find the one that suits you best. (see BUPA fact sheet, link below) Cognitive Behavioural Therapy also cannot take the place of antidepressant medication, if it needed to help treat severe depression.  As Cognitive Behavioural Therapy involves effort and self discipline, it may need to be used alongside medication, because changing thinking patterns may seem impossibly difficult until antidepressants have started working to make you feel better.

Recurrence

Finally, BUPA state about half of people who have an episode of depression will have another episode (BUPA fact sheet). Over a period of 15 years, almost 90% of people that have suffered an acute depressive episode will face a recurrence of symptoms. (Nierenberg, Petersen & Alpert, 2003)

If stressful events arise in life, and feelings of anxiety, depression or other negative feelings return, the skills learnt through Cognitive Behavioural Therapy should help you tackle them and keep them under control. Some evidence on the Royal College of Psychiatrists website suggests CBT may be more effective than anti depressants in preventing depression from coming back. This demonstrates how a course of Cognitive Behavioural Therapy can have long reaching positive consequences.

References/ Further reading

Cognitive Behavioural Therapy London (CBT) London

All you need is cognitive behaviour therapy? Jeremy Holmes, 2001

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122202/

Cognitive-Behavioral Therapy for Generalized Anxiety Disorder – What CBT is and Why it Works William Meek, 2001  http://gad.about.com/od/treatment/a/cbt.htm

Royal College of Psychiatrists website, clear online leaflet http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx

Depression, online factsheet published by Bupa’s health information team, April 2008.

http://hcd2.bupa.co.uk/fact_sheets/html/depression.html

Q and A with David Clark , professor of psychology at King’s College London and director of the Centre for Anxiety Disorders and Trauma at Maudsley Hospital. http://www.nhs.uk/Conditions/Cognitive-behavioural-therapy/Pages/Questionstoaskpage.aspx

The Big Question: Does cognitive therapy work – and should the NHS provide more of it for depression? Jeremy Laurence Health Editor, The Independent

http://www.independent.co.uk/life-style/health-and-families/health-news/the-big-question-does-cognitive-therapy-work-ndash-and-should-the-nhs-provide-more-of-it-for-depression-1925439.html

Nierenberg, A. A. Petersen ,T.J. Alpert, J. E. (2003) Prevention of Relapse and Recurrence in Depression: The Role of Long-Term Pharmacotherapy and Psychotherapy, The Journal of Clinical Psychiatry Vol 64, 15 At http://www.psychiatrist.com/pcc/pccpdf/v05s09/v64s15.pdf

Briers, S. (2009) Brilliant Cognitive Behavioural Therapy, Harlow: Pearson Education Limited

Author: Emma Bender

Harley Therapy: Cognitive Behavioural Therapists London

PressRelease: London, 24 March 2010. Enquiries have continued to grow for cognitive behavioural therapy (CBT) since Harley Therapy, a therapy service in Central London, first observed a growing trend in 2006. More established talking therapies, such as psychodynamic, gestalt, existential, person-centred or psychoanalytic therapy now appear to have been overtaken by CBT.

45% of enquiries for adult individual therapy (not including couples therapy, or child & adolescent counselling)) over the past 3 months have been for Cognitive Behavioural Therapy rather than any other therapeutic approaches on offer.

Clinical Director, Dr Sheri Jacobson believes that the popularity of CBT stems partly from the government’s roll out of CBT programs incorporated in the IAPT initiative (Improving Access to Psychological Therapies). IAPT was set up to support NHS Primary Care Trusts in implementing NICE (National Institute for Health and Clinical Excellence) guidelines for individuals suffering with depression and anxiety. It offers a stepped level of care starting with assessment and guided self-help and moving on to delivery of CBT in the cases of most mental health issues. CBT will be offered for panic disorder, social phobia, generalised anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder and depression*. See NICE guidelines for full details guidance.nice.org.uk

“There has been a lot of publicity related to CBT programs within IAPT which is helping to inform the public about CBT and the types of issues it can help with.“ says Dr Jacobson. She finds that word of mouth is also spreading; “individuals with positive experiences of CBT have been recommending it to others. We are getting more enquiries from individuals saying that their friends/colleagues have had a course of CBT and suggest they give it a try.” Many of Harley Therapy’s referrals come from local private GPs and psychiatrists. These health practitioners will be aware of the range of approaches to therapeutic treatment, and yet the majority of their referrals are now for CBT. “In part this is due to the fact that CBT can bring symptom relief quicker than with other therapies, and thus client’s feedback of CBT therapists tends to be more positive. As more health practitioners are recommending CBT, more of the public is alerted to its existence and its advantages. Internet users are openly discussing the benefits of CBT for conditions such as OCD, panic and anxiety on website forums such as stuckinadoorway.org”

Additionally, the economic downturn seems to be impacting the private therapy sector. However, rather than falling referral rates, the administration team at Harley Therapy have observed a shift in the types of referrals. Cognitive Therapy may be viewed as more economical – it is designed to be a short-term therapy, spanning over 6 to 20 sessions. Much depends on the complexity of the presenting issues, how long-standing the issues are and the extent of the client’s goals. However, on average, CBT therapy is much shorter-term than conventional therapies (psychodynamic, humanistic, existential, gestalt, interpersonal) and can help with cost-saving.

Another interesting shift observed at Harley Therapy is that individuals are turning to their private health insurance to cover the cost of the sessions. “Since the start of the year, we have witnessed a significant increase in requests for appointments with therapists who are registered with the major health insurance groups such as BUPA, AXA PPP, Cigna and Pruhealth. Providing that certain criteria are met, policy-holders can receive private therapy free of charge. More and more prospective clients would rather claim on their insurance rather than pay from their own pockets” says Jacobson.

But is CBT really that effective? CBT has been subject to numerous trials, and compared to other interventions. In the majority of studies, it comes out on top.

One reason why CBT is believed to be more effective than other studies, is due to the fact the other therapies are not always quantifiable. An integral part of CBT is the use of standardised measures, which means that progress can be quantified. The same cannot be said of the more traditional therapies, which may focus less on measures and inventories. However, this still cannot explain the positive feedback that clients usually give after a series of CBT sessions, and why they go on to recommend it to others.

CBT has a unique set of features which may explain its effectiveness. Once a client’s main problems are formulated and goals are set, the therapist and counsellor work to revise negative thought patterns and unhelpful behaviours. CBT makes use of tailor-made exercises – clients may test their negative predictions and try new ways of acting. It is these cognitive and behavioural shifts which can bring about new discoveries and associated improvements in mood.

The biggest danger of the rise in popularity of CBT is the misperception that it can help everyone, and indeed rid individuals of their problems. Whist many CBT clients will notice improvements, no permanent ‘cure’ is offered. Any improvements are achieved by acquiring a set of tools, and clients are encouraged to practice these skills and become their own guide. After initial improvements are made, ongoing commitment and hard-work are required to maintain these.

CBT does not suit everyone, and not all CBT therapists are the same. Some individuals have undergone CBT only to find they progress further with another therapist or a different approach. Many psychological issues that are deep-rooted and complex may do better under a psychodynamic or existential perspective. Other issues such as bereavement may do better with a humanistic counsellor.

There is a danger that conventional talking therapies are overlooked. It is useful for the public to learn about the different therapeutic approaches so they can make informed choices. Harley Therapy produces a number of theses: http://www.harleytherapy.co.uk/counselling/ If individuals are seeking therapy in the private sector, it can helpful to be assessed by a counselling psychologist trained in a variety of approaches.

There is no doubt that CBT is on the rise, and this is a trend that looks set to continue.

* Counselling, couples therapy or interpersonal therapy may additionally be offered for depression, and EMDR (eye-movement desensitisation and reprocessing) may be offered for Post-traumatic-stress disorder.

Harley Therapy offers a full range of talking therapies at Harley Street offices including Cognitive Behavioural Therapy CBT London, Psychodynamic, Existential, Person-Centred and Gestalt Therapy.

1-7 Harley Street, London, W1G 9QD
0845 474 1724

CBT London.

Cognitive therapy London, CBT Counselling London, cognitive therapist, cbt Psychologist, cognitive counsellor, cognitive behavioural therapy, cognitive Psychiatrists, central London, city london

Congratulations – you are enrolled on a counselling course!  You are now at the stage of seeking a counselling placement.

The following guide answers some commonly asked questions and offers five tips for securing a placement.

What is a counselling placement and why do I need one? A placement within an organisation will provide you the opportunity to work with clients under supervised conditions. Placements are a mandatory part of most counselling courses and necessary to practice the skills you have been taught. To become accredited by a counselling or psychology body (e.g. BPS, BACP, BABCP, UKCP, BACP) Harley Therapy©, you will need to demonstrate a certain amount of clinical hours. Normally these are obtained in a clinical placement. Often, you will have more than one placement over the course of your training. 

Why is it so difficult to find a placement? Counselling, psychotherapy and psychology are very popular fields. Many counselling agencies are inundated with requests for placements. Those that can accommodate trainees can afford to be choosy because of an abundance of applicants. Be prepared that most placements will be un-paid, though some may reimburse for travel expenses.

What can I do to maximise my chance of securing a placement?

1. Make use of any in-house services. Many counselling courses will have a placements co-ordinator who has links with counselling agencies.

2. Check on Notice-boards in your educational establishment. Many organisations will send bulletins to advertise their need for volunteer counsellors. 

3. Try to be flexible. Even though you may have a preference for working in a particular setting e.g. bereavement, the wider your application, the better. Accepting work in another field e.g. drug & alcohol, will add to your breadth of experience, and chances are you will enjoy the work.

4. Polish up your CV & tailor-make your covering letters. Rather than sending out a generic application, try and gear your application towards the agency’s speciality.

5. Approach well-recognised organisations. Establishments such as MIND have years of experience in providing placements in many of their local branches. Try writing to these organisations in addition to smaller local centres. Private counselling settings are not always ideal for placements as they may not be designed to give the support and mentoring that a trainee needs. For example, Harley Therapy is a network of independent therapists and at present does not have the scope to provide the resources you need for a rich training experience.

Finally, here are some things you should look for in a placement:

1. Supervision with an accredited supervisor.
2. Training opportunities such as workshops & lectures
3. Network of peers at a similar training level.
4. Good line-management or mentoring.
5. Safe environment, where you are not seeing clients out of your depth. 

We hope these comments help. Please feel free to add your experiences….

Facebook, MySpace and Twitter are testament to the reach and influence of the internet and to the evolution of traditional social contact. So it is too with psychological therapies, which are increasingly being offered ‘online’.

Harley Therapy has introduced online counselling and therapy services in response to requests for quality counselling outside its central London practices.

Whether you are in London, Ontario or London, England, you can now access a professionally trained counsellor through the internet.

Online counselling typically entails a 50 minute interactive counselling session. If you have a webcam you can see and talk to the therapist directly. Many of the elements of a traditional counselling session are preserved. If you don’t have a webcam, then it is possible to communicate in real-time with Windows MSM or Yahoo Messenger or Skype.

Dr Sheri Jacobson whose psychotherapy and counselling training spanned 9 years was initially sceptical about this mode of therapy. “I thought that the dynamic of live face-to-face contact and its associated non-verbal cues would be lost in online counselling. Also, in a regular counselling we can provide a safe physical space free from interruption, whereas online counselling relies on the client setting this up. However, I have come to appreciate that there is a growing demand for services through the internet. In particular, online counselling suits those individuals who travel frequently or who live abroad.”

Conducted properly, online therapy can have many advantages. Dr Jacobson remarks that “communication via a webcam can lower people’s inhibitions. Some people feel more open on a webcam and may be quicker to reveal personal problems than in person. “

For some, online therapy is a way of dipping their toes into the world of therapy but for others it replaces weekly face-to-face sessions.

With the advent of online support groups and computer therapy programs such as the government-backed ‘Beating the Blues’, we are likely to see more demand of online counselling services.

Becky Wright, is an online counsellor and has been working in this medium for many years. She is available for webcam counselling and email therapy exchanges.

Harley Therapy’s London therapists and counselling psychologists work with all issues including with anxiety therapy and relationship counseling

Conflict and disagreement are inevitable in relationships. Anger is a natural emotion, and disagreements can be healthy sign of difference. Conflict usually occurs because certain needs are not being met – either within the relationship or outside or it. The object of conflict management is to ask for those needs to be met in a way that does not damage your relationship.

Here are some tips that may be useful to manage anger and reduce conflict.

1. TAKE TIME-OUTS. Disagreements are best dealt with when both parties are in a non-aroused state. Whenever possible, take a time-out to calm your body down. Techniques include breathing, relaxation & visualisation (see separate self-help guide). Strong emotions of anger, grief or anxiety do not make it easy for us to access our rational faculties and so there is little benefit of trying to address disagreements in this condition – it often just escalates into insults and unintentional dagger-throwing. Both of you should respect each other’s need for a time-out; it’s not running away from the issue, but preparing yourself to deal with it in more receptive mode.

2. REFLECT INTERNALLY. Check in on yourself and ask yourself what you think the issue is about. Ask yourself what part you are playing in this – are you misinterpreting what your partner has said? Are you in a bad mood from something else? Are you being reasonable here? Ask yourself if you think it is an issue that is important enough to stand your ground on – can you let this go without resentment or do you need to ask your partner for something? Sometimes we argue out of habit and because it connects us (even though it is negative, at least we both get attention). Ask yourself whether you really need to take up this issue. If so, think about what exactly you need to ask for.

3. EXPLAIN. Avoid presuming that your partner should know what is wrong. Empathy is an elusive concept – it is nearly impossible for another person to truly know what you are experiencing and to give you what you want. It useful if you can ask for what you need.

4. TAKE PERSPECTIVE. There is sometimes great temptation to elevate the stakes in an argument. Threats and ultimatums are damaging to the ego and chip away at the whole of the relationship. Thus, try and keep the argument to the specific issue rather than make the whole relationship at risk. Avoid ‘if you do this one more time…’ ‘I can’t take this any more, I’m leaving’… Each of you should know that however unpleasant this disagreement is, it will not touch the relationship. If the relationship is to end, it should be decided separately to a heated argument.

5. TRY TO PERSONALIZE. The conversation is best approached from a personal angle, rather than blaming your partner. If your partner hears criticism he/she will want to defend himself/herself rather than address the issue. Try and use ‘I feel…’, ‘It hurts me when…’, ‘I would really like it if…’, rather than ‘you make me feel…’, ‘when you do that….’. Try also to avoid generalization such as ‘you always do that..’, ‘you never think…’ – it is certainly hurtful and is usually inaccurate.

6. OWN UP TO MISTAKES. It is not a weakness to accept that you have acted out of line. Owning up to faults and mistakes is helpful to both parties, so long as it is not done out of martyrdom or for manipulative effect. Apologising early can save a lot of unnecessary conflict.

7. INCLUDE SOMETHING POSITIVE. When putting your point across, it brings good results if you can refer to something positive as well. The discussion is unlikely to be rosy, but if you can draw on aspects that you do like, it will make your partner less tense and combative. Putting across negative points in a humorous way can also work. Humour doesn’t mean your partner is trivialising the issue, rather it makes it easier for him/her to confront an issue.

8. FOCUS ON THE PRESENT. By clinging to the painful memory of a past event (no matter how distressing it was) you are impeded from living in the present. You are entitled to a period of grieving and are allowed to make your needs clear to your partner. Long-held resentment will tarnish a relationship. Harley Therapy© Try not to use past events as ammunition. Even though it might be a recurring issue, the current disagreement should address the here and now.

9. AIM TO BE HAPPY, NOT TO BE RIGHT. The purpose of approaching conflict is to get to maximum results for both of you. When you argue to win (by point-scoring), the gain is short-term and mostly leaves you feeling worse. When you argue to ask for your needs to be met, it is still unpleasant, but you are working to building better conditions for both of you.

10. AGREE TO DISAGREE. You are entitled to ask your partner to help meet your needs, but you are not in the business of getting your partner to come around to seeing the world as you do. It is fruitless to try to convert them to your philosophy of life. Differences should be embraced – including different sets of interests and activities. Finally, it is not up to your partner to fulfil all of your needs, they also have to be met internally and with other people (family, friends).

Disclaimer:

The above tips represent a set of tools for anger and conflict in relationships. They are not easy to incorporate, but with practice, your relationship will hopefully improve. If these self-help tips do not have any effect, or seem too difficult to adopt, you may benefit from more in-depth psychotherapy to examine the underlying causes of your anger (which may be related to personality difficulties and earlier history). See Anger Management London and Relationship Counselling London for private psychotherapy and counselling services.  If you or your partner’s anger escalates into physical or emotional abuse, then it is strongly advised that you seek help from a third party or external organisation.

This free self-help guide, written by Dr Sheri Jacobson, is intended for educational purposes only. It is not a substitute for a professional consultation with a qualified psychotherapist or counsellor. The author does not take responsibility for any outcome relating to the guidelines. You may copy or distribute the content in line with the creative commons license provided you acknowledge and link back to the original source. http://www.harleytherapy.co.uk/counselling/ten-tips-for-anger-management-in-relationships.htm

Please feel free to leave a comment and share your experiences in anger-management in relationships.

Harley Therapy reports continued growth in demand for Psychotherapy and Counselling Services in London. Its therapists have seen further rises in referrals despite the current recession. The most recent statistics from Harley Therapy show that the demand for counselling has risen 18% year on year.  Harley Therapy has taken on further therapy premises in an effort to accommodate such growth.

Clinical Director, Dr Sheri Jacobson comments ‘this is a remarkable trend given that the majority of the economy is retracting. In part, I believe that the increases in demand are linked to the recession itself since it is likely to give rise to a host of issues that lend themselves to therapy. Job losses or the threat of redundancy can give rise to depression and stress. Financial worries can create significant anxieties and relationships can become strained as a result.’

How is it possible that people have less disposable income and yet there is a surge in demand for private therapy? One answer is that individuals are increasingly recognising the priority of mental health; many are keen to work through issues early on rather than letting them snowball into larger problems. Jacobson finds that clients are eager to nip the problem in the bud. ‘This seems to reflect a growing acceptance of counselling and psychotherapy; an acknowledgement of the importance of talking therapies in improving one’s mental well-being and pattern of relationships. What was once taboo no longer has as much stigma. The recession may have taken the edge of this trend, due to financial restrictions, but not entirely. Even those whose income has declined are still willing to aside funds for therapy’.

Harley Therapy also reports that a growing number of individuals are seeking therapists who can provide shorter-term therapy programs such as Cognitive behavioural therapy. This can work out to be more cost effective than say an extended period of three or four times a week psychoanalysis. Harley Therapy also record that more individuals are seeking appointments with London Counselling Psychologists who are registered with the major health insurance providers such as BUPA, AXA or Cigna. A further trend is the rise in partners seeking couples counselling, also up by nearly 20%.

Dr Jacobson feels that there is a further explanation to the growth ‘We come across a number of individuals who are eager to get started on a course of therapy, and have been disconcerted with long waiting lists elsewhere. Many individuals also prefer not to have their mental health reviews on NHS records and will opt to see a private therapist instead.’

It seems that there are indeed some areas of the economy that are less vulnerable in this recession. This is a fortunate piece of news for the many individuals who have started training to become a psychotherapist or counsellor.

Harley Therapy operates Psychotherapy and Counselling Rooms in Harley Street, Central London.  The practising therapists are registered with the British Association for Counselling and Psychotherapy, the British Psychological Society, the British Association for Cognitive and Behavioural Psychotherapies or the United Kingdom Council for Psychotherapy. Harley Therapy offers free counselling information guides on its news page Counselling News

Person-Centred / Humanistic Counselling is a supportive form of therapy where you are given the space and safety to share your concerns. Person-Centred / Humanistic Counselling is based on the philosophy that individuals are full of potential for growth. Given the right conditions, people are all capable of being loving, creative and knowledgeable. Humanistic therapy evolved in the 1950s and 1960s in the USA as part of a ‘human potential movement’.

A Person-Centred Counsellor will ask questions which lead you to deep discoveries about your feelings, your blind spots, your needs and your hopes. Person-centred Counselling forms the backdrop to all our counselling work. Your therapist will be empathic, understanding, supportive and non-judgemental.

More on Person-Centred / Humanistic Therapy