Tips for Getting the Most out of Psychotherapy (a service receiver’s view).
Tips for Getting the Most out of Psychotherapy
(a service receiver’s view)
To access psychological therapies it must be agreed by your consultant psychiatrist with input from your care co-ordinator. Don’t be afraid to ask them about psychological therapy and discuss the options available to you.
I have had several types of psychotherapy over the years and these experiences have been extremely varied in effectiveness and outcome.
I believe that the more information you have about therapy, the better the outcome, so do some research on the web on the type of therapy offered and ask questions all the way through for a better experience.
Research has shown that the skill of the therapist and the quality of the therapeutic relationship is the primary indicator of effective therapy, but you can also do a lot as a client, to maximise the benefits.
1. Be Aware of Informed Consent
Before commencing therapy, make sure that you understand informed consent. Informed consent is defined as the voluntary and continuing permission of the patient to receive a particular treatment based on an adequate knowledge of the purpose, nature, likely effects and the risks of that treatment, including the likelihood of its success and any alternatives to it (Mental Health Act Code of Practice, 1999). If you are not sure of what this means, ask your therapist and don’t sign or agree to anything until you fully understand it.
2. Ask Questions During the Assessment
The therapist will spend the first few sessions undertaking an assessment. For example, in Cognitive Behavioural Therapy (CBT) this could take the form of completing a timeline of your illness life history, completing various questionnaires on anxiety and depression or values and asking you about your current issues as you see them. In Cognitive Analytical Therapy (CAT), you may be asked questions about your childhood and relationships and will be given a questionnaire (called a Psychotherapy File) and asked to identify your unhelpful patterns of thinking and behaviour. If you are not sure of why the therapist is doing this or what is applicable to you then ask. The assessment will be more beneficial if you can give a more accurate picture based on a better understanding of what is going on.
3. Ask to see the Psychological Formulation
The therapist will prepare a psychological formulation (treatment plan) based on the findings of the assessment, which varies according to what type of therapy is being used and your unique situation and issues. For CBT an example could be a summary of your case history, any findings from the assessment, a hypothesis to work on during therapy, a summary of your current issues and an action plan for therapy. Psychological formulations are often presented in diagrammatic form. Not all therapists will automatically show you the formulation, but I have personally found the formulation to be extremely useful in understanding my issues and motivating me in therapy, so I would recommend asking your therapist if they will share the formulation with you and explain it to you in terms that you can understand. Your ongoing informed consent in being fully aware of the purpose and goals of therapy is also important in this respect.
4. Make sure the Intervention is Properly Explained
Once the therapist has established the formulation document, they will start to work on your existing or past issues with you using various different psychological techniques. This is known as the psychological intervention. For example, a therapist using CBT may ask you to complete thought diaries of your automatic thoughts, to establish any cognitive thinking errors, and help you challenge your thoughts. If you are not sure at any stage how to complete these or why this is important then ask the therapist. Personally, I like to know exactly why I am doing any technique, what the goal is and how it relates to the formulation, so I recommend asking the therapist if you are not sure. This makes sense as the more information the client has, the more motivated they will be and the better they will be able to complete the techniques.
5. Be Honest with your Therapist
Don’t be afraid to tell your therapist if something is upsetting you, or if you are having strong positive or negative feelings towards the therapist or about the therapy as this needs to be discussed and dealt with before it becomes a problem.
6. Give the Therapist Feedback
Tell your therapist if you have found therapy helpful and why. Which techniques were the most helpful? What did you have difficulty with? I believe that therapists often assess the outcome of therapy on the evidence within the clinical notes, without actually asking the client upfront and they may miss something obvious like if a technique was particularly difficult and needs to be presented in a different way. You are entitled to see your clinical notes, so if you are concerned about anything, or want further information just ask.
7. Ask for Copies of Useful Documents
Don’t be afraid to ask for a copy of the psychological formulation or any techniques that you have found particularly helpful. The aim of therapy is to enable you to “become your own therapist”, so the more useful techniques that you can take away and use after therapy the better. You could also ask the therapist if they can recommend any self-help books that you could read to consolidate what you have learnt in therapy.
For more information about the different types of psychological therapies available please see the following article: