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Thursday 19 October 2017
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Interested in having Psychological or 'Talking' Therapy?

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What is Talking Therapy and why is it used?

Talking therapy is a way to explore your difficulties with a trained professional, sorting through your problems to get some relief from tension, have a safe place to explore how you are feeling, gain a new understanding of your problems and plan what you want to do to overcome them. There is a large body of evidence to support its effectiveness for a range of mental health problems.

How does it work?

The first step will be to have an assessment. This may take place over the telephone or face to face. The aim of the assessment is to get an idea of your current problems, how they affect you in your day to day life, explore what changes you want to make and to make a joint decision on the best type of treatment for you. If this is not with our service, you will be given information on the best place for you to go for help, or we may make a referral to appropriate service. If you do go on to have sessions with us, you will meet with your therapist and on a regular basis (this may be by phone, over the internet or face to face) which you will set up together. This would usually be weekly to start with. Sessions may last up to an hour, depending on the type of therapy you have, or up to three hours for group therapy. The sessions will give you a place to explore what is important to you, to get things off your chest, develop a different perspective on your problems, and makes plans for moving forward.

Behavioural Couple’s Therapy?

This offers relationship support to a couple where at least one partner has depression. Most sessions will be for both people, but individual sessions may also be scheduled if needed. Regular hourly sessions may be offered up to a maximum of 16, although some cases need fewer meetings.
The therapy is designed to help each partner to understand the origin and effects of depression;  how it impacts on their relationship and how the relationship impacts on the depression.

Cognitive Behavioural Therapy (CBT)

CBT is based on a shared knowledge in an equal, collaborative working relationship. The therapist and client will work together to explore how different problems are established, maintained and how the client can begin to make changes.  CBT acknowledges that earlier experiences can shape the way a person thinks, feels and behaves but the focus of the therapy is on current difficulties. The sessions are structured and between session activities are agreed to help with exploration and progress. Outside the sessions, the client will practice techniques to test their assumptions and this helps develop confidence in new ways of handling their situations. Depending on the type or severity of your problems, you may be offered guided self help, offered by our team of Psychological Wellbeing Practitioners. This may be offered by telephone or face to face.  Alternatively, you may be referred to our CBT therapists. They offer hour long sessions, usually delivered weekly, with an average course of treatment being between 6 to 8 sessions. These may be offered via an online platform if the client prefers.

Counselling

Counselling offers the opportunity to talk about any issues that are causing concern.  The aim of counselling is to find ways of managing situations more satisfactorily, either by making changes, or finding new ways of managing difficult feelings. Counselling is a safe place to work through a situation with support and in a safe place to reflect.There is no ‘one style fits all’; one person may wish to reflect on long term difficulties and lifetime experiences, another will want simply to concentrate on a particular issue in the present. The focus of the sessions with be agreed at the beginning of treatment.

The different types of counselling available in the service are detailed below.

Counselling for Depression (CfD)

Counselling for depression is an evidence-based form of therapy which is particularly helpful for people experiencing depression.  CfD counselling may also suit people with low self -worth, grief, relationship difficulties, life cycle adjustments, or who are struggling to cope with life stress. It views depression as primarily an emotional problem brought about by conflicting mental views, for example, being too critical of oneself, feeling worthless, being left with unresolved feelings from difficult relationships, or other experiences. It can help get in touch with underlying feelings, to express and make sense of them. 

Dynamic Interpersonal Therapy (DIT)

DIT is a time-limited therapy based on psychodynamic theory, specially developed for the treatment of depression.  It aims to help make connections between depression symptoms and what is happening in relationships, with the belief that dealing with relationship problems more effectively can help psychological problems improve. DIT may last for up to 16 sessions. The client and the therapist work together to identify a key, repetitive pattern of relating to others which can often be traced back to childhood.  DIT does not involve any written exercises or homework but the patient needs to be interested in working in the area of relationships and to be actively looking for ways to make constructive changes.  For more information on DIT you can visit the following websites: www.d-i-t.org and www.iapt.nhs.uk/silo/files/which-talking-therapy-for-depression.pdf

Interpersonal Psychological Therapy (IPT)

IPT aims to reduce symptoms of depression and improve the quality of relationships. To be suitable for this treatment, clients will be depressed or recurrently depressed as well as have relationship issues which they believe cause the depression.These issues may be about conflict, change and loss in relationships, complicated bereavements, or lack of supportive/enjoyable relationships including difficulty achieving a give and take balance. In IPT ways of communicating with others is analysed in order to to improve these communcations. Between sessions tasks are not normally given. There are three distinct stages in this type of therapy, consisting of an introductory phase to help the patient to understand the treatment and make an inventory of relationships to assess significant people in the patient’s life and begin to understand where difficulties may lie and where support may be found. Strategies to cope better with unsupportive people can be explored. Once the focus of the therapy is established, goals are agreed. During the middle sessions,the focus is on understanding issues and themes as they arise and agreeing strategies to make improvements. There are normally 4 to 6 of these sessions with a review at session 7. The last phase is moving into recovery, with ending strategies implemented, progress in therapy reviewed, time spent thinking about the future and planning how to deal with any difficulties that may lie ahead. This phase includes discussion about how to maintain improvements in relationships, prevent relapse, needs for future use of medication and possible re-entry to treatment.

Psychosexual Therapy

This is a service offered to couples or individuals who are experiencing sexual problems such as loss of interest or desire, painful sexual intercourse, being unable to achieve penetrative sex, inability to achieve or maintain an erection, inability to reach orgasm.

For therapy to commence, it must be established that there is no physical or medical reason for the problem. Once this is clear, the history of the problem is explored and the clients and therapist decide whether or not to go on to a programme of treatment. This consists of tasks set by the therapish and carried out by the clients in the privacy of their own home. Clients use sessions to report back on  their progress. The programme assists clients to feel good about their bodies and helps them to gain knowledge and confidence about their sexuality. Most of the sexual problems that we work with are caused by anxiety, lack of confidence, lack of sex education, poor body image or problems within the relationship. During the sessions the therapist will help clients talk about sexual concerns, as well as explore the possible sensitive areas in relationships. Clients are NEVER be asked to undertake sexual tasks during sessions, but may be asked to carry out certain simple, quite specific tasks - alone or with your partner - in the privacy of your own home. These tasks will be tailored specifically to that problem and are directed to helping the particular difficulty identified.

Eye Movement Desensitisation and Reprocessing (EMDR)

This type of therapy focuses on using eye movements to stimulate that part of the brain where disturbing or emotionally charged material has been 'locked in', usually during a traumatic event. It aims to enable clients to reprocess that disturbing material to begin healthy healing and resolve any issues relating to it.  EMDR therapy is an eight-phase treatment. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level, so for instance, a rape victim may shift from feeling horror and self-disgust to holding the firm belief that, "I survived it and I am strong."

Systemic Therapy

This is a brief therapy, for people aged 16 - 19 who wish to attend with thier fsmily or caregivers. This type of therapy aims to understand mental health problems by helping family members, couples and others who care about each other to express and explore difficult thoughts and emotions safely, to understand each other’s experiences and views, appreciate each other’s needs, build on strengths and make useful changes in their relationships and their lives. Individuals can find Systemic therapy helpful, as an opportunity to reflect on important relationships and find ways forward. Research shows Systemic Therapy is useful for children, young people and adults experiencing a very wide range of difficulties and experiences.

Group Therapy

Group therapy is just what it sounds like - instead of just one person, therapy is with a group of people. There is good evidence that group therapy is very effective for certain problems, such as depression and long term conditions. For some people, having individual therapy can feel intimidating, and group therapy may be a good option. In addition to demonstrating that you are not going through this alone, group members can share information and support to each other. All group therapy is led by a qualified therapist, and clients get comparable results to those who have one to one therapy.

Depression Self-Assessment Questionnaire

The simple questionnaire can help you to decide which type of treatment is best for you;

(Alternatively, you can use the NHS Choices Depression Self-Assessment below which asks similar questions).

PHQ-9
Depression Self-Assessment Questionnaire

Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the week Nearly every day
1 Little interest or pleasure in doing things 0 1 2 3
2 Feeling down, depressed or hopeless 0 1 2 3
3 Trouble falling or staying asleep, or sleeping too much 0 1 2 3
4 Feeling tired or having little energy 0 1 2 3
5 Poor appetite or overeating 0 1 2 3
6 Feeling bad about yourself - or that you are a failure or have let yourself or your family down 0 1 2 3
7 Trouble concentrating on things, such as reading the newspaper or watching television 0 1 2 3
8 Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual 0 1 2 3
9 Thoughts that you would be better off dead or of hurting yourself in some way 0 1 2 3

The copyright for the PHQ-9 was formerly held with Pfizer, who provided the educational grant for Drs Spitzer, Williams and Kroenke who originally designed it.This is no longer the case and no permission is required to reproduce, translate, display or distribute the PHQ-9.

Add up your scores for sections 1 - 9. If your total score is 9 or under, research suggests the best course of treatment for you is Self Help that you can work through at your own pace. Search for Depression Self Help Groups in your area.  

If your score is 9 or over, then you may benefit from Talking Therapy – either Counselling (such as Counselling  for Depression, Interpersonal Therapy or Dynamic Interpersonal Therapy) or Cognitive Behavioural Therapy (CBT). You can talk about which type of therapy would be best for you at your assessment. 

content provided by NHS Choices

Anxiety Self-Assessment Questionnaire

This simple questionnaire can help decide which type of treatment is best for you;

GAD-7
Anxiety Self Assessment Questionnaire

Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the week Nearly every day
1 Feeling nervous, anxious or on edge 0 1 2 3
2 Not being able to stop or control worrying 0 1 2 3
3 Worrying too much about different things 0 1 2 3
4 Trouble Relaxing 0 1 2 3
5 Being so restless that it is hard to sit still 0 1 2 3
6 Becoming easily annoyed or irritable 0 1 2 3
7 Feeling afraid as if something awful might happen 0 1 2 3

Source: Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.

Add up your scores for sections 1 - 7. If your total score is 7 or under, then Self Help is the recommended course of action - link to library catalogue for self help books.

If your score is 8 or over, then you may benefit from CBT.

The NHS Choices Mood Self-Assessment below, asks similar questions about both Mood and Anxiety;

content provided by NHS Choices

Phobia Scales Self-Assessment Questionnaire

This simple questionnaire can help decide which type of treatment is best for you;

Phobia Scales Self-Assessment Questionnaire

Indicate in the boxes on the right hand side how much you would avoid each of the situations described below, for the specific reasons given (indicated in italics), using this 0-8 scale:
0 1 2 3 4 5 6 7 8
Would not avoid it Would slightly avoid it Would definitely avoid it Would markedly avoid it Would always avoid it
Social situations due to a fear of being embarrassed or making a fool of myself
Certain situations because of a fear of having a panic attack or other distressing symptoms (such as loss of bladder control, vomiting or dizziness)
Certain situations because of a fear of particular objects or activities (such as animals, heights, seeing blood, being in confined spaces, driving or flying).

The IAPT Phobia Scale is reproduced from the IAPT Toolkit which is ©Crown copyright. Reproduced under the terms of the Open Government Licence.

Add up your scores for sections 1 - 3. If your total score is under 4, self help is the best option for you.

If your scores are higher, then CBT is the recommended treatment.


Impact on Daily Activity

Work and Social Adjustment Self-Assessment Questionnaire

This simple questionnaire can help decide which type of help or treatment is best for you;

Work and Social Adjustment Questionnaire


Sometimes people's problems can affect their ability to do certain day-to-day activities. Please indicate in the boxes on the right hand side how much your problems impair your ability to carry out each type of activity listed, using the 0-8 scale below
0 1 2 3 4 5 6 7 8
Not impaired Slightly impaired Moderately impaired Markedly impaired Severely impaired
Because of my problems my work is impaired (please put N/A if you are not currently working)
Because of my problems my home management is impaired. (cleaning, tidying, shopping, cooking, looking after home/family, paying bills etc)
Because of my problems my social life is impaired (activities with other people, e.g. parties, outings, entertaining etc)
Because of my problems my private leisure activities are impaired. (activities done alone, such as hobbies, reading etc)
Because of my problems my family and relationships are impaired (forming and maintaining close relationships with others, including the people you live with)

Mundt, J. C., I. M. Marks, et al. (2002). "The Work and Social Adjustment Scale: A simple measure of impairment in functioning." Br. J. Psychiatry 180: 461-4.

Add up your scores for each section. If your total score is below 10 you may benefit from accessing self help resources. If your score is above 10 and you also have a score of 10 and above on the PHQ9, or 8 and above on the GAD7 (or both) you may benefit from a referral to our service.


Self referral Form 

TMHD self-refer button

What can I expect from Therapy?

Coming to your first session can be nerve wracking, so this section is to help you understand what to expect. Dont worry that you will be judged, or subjected to interrogation - these are normal fears, but therapy is a process to help you, and the first thing your therapist will want to do is help you feel comfortable with them.

In your assessment, you will talk to a trained professional who will talk you through different aspects of your current problem, in order to direct you to the best type of therapy for this.They will also tell you about the waiting times for the type of therapy you want. 

In your first therapy session your therapist will want to find out from you how you are at the moment, and give you a standard set of questions (commonly referred to as the measures, or IAPT standard data set) to establish where you are starting from. These are explained in more detail below. This is also the time to talk about what you want to get out of your sessions, and how you will best work together - for example, times and dates, and whether the therapy will be face to face or by phone. They will also explain the rules that they work under such as confidentiality and how they keep their notes, and communicate with your GP. In order to see people as quickly as possible and keep waiting times down, all of our therapist will need to close cases if you do not attend 2 sessions without notice, or giving us very short notice. If you have special circumstances, this can be discussed with your therapist (such as working shifts), but in general, for therapy to work, you need to be able to commit to coming every week or two for a period of a few months.

You may decide, after this session, that you do not wish to continue, or to work with that particular therapist. This is fine, and you are free to leave whenever you wish. However, it can be helpful to talk about why this is, if you can. Your therapist may be able to refer you to a service that would be more suitable for what you want. If you do not want to continue, and do not want to discuss this with your therapist, you can call our office and speak to a member of the admin team, who will be able to help with this. This is your therapy, and it is important that you feel comfortable with your therapist, so if for some reason you don't, please tell us.  

Our therapist work with clients in many different ways, and will probably explain their way of working with you. More information on this is available in the 'what type of therapy might I have' tab. You can always ask questions - in fact, the more the better! If you want to ask about how that therapist works, their experience or qualifications and whether they have worked with a problem like yours before, you are always welcome to do so.. Our staff are all trained to expect and welcome questions like this.

Your therapy is very personal, and will involve talking abut things that are painful and difficult, or make difficult decisions, so you may feel worse before you feel better. This is normal, and is nothing to be afraid of. However, if you really feel this is not working for you, you should talk to your therapist about ending your therapy, or referral to another service.

How can I access the service?

One of the unique features of our service is that you can access it easily, by self-referral.  There are various ways to do this: online, by telephone on 0300 123 0542, or by completing the self referral form on one of our service leaflets.  You may also be referred to the service by a health care professional, such as your GP.

I work in the day; can I self refer by telephone, out of hours?

Yes, when you call, select option 2 and you will be able to leave your details; we will send you an appointment within 10 working days.

I am on benefits and don’t have much credit on my phone, can you call me back?

When you call in, be ready with your telephone number and we will call you back; or you can leave a message to request a call back.

I am not very good on the phone; can someone else speak to you on my behalf?

Yes, but we would need you to give your permission first.

Will I have to pay for the service?

No. Talking Mental Health Derbyshire is part of Derbyshire Healthcare NHS Foundation Trust and as such is free at the point of access.

Do you provide appointments outside of the usual 9am-5pm working hours?

Our core working hours are 9-5pm.  On occasion we may be able to offer appointments outside of these times.  However, this may mean an additional wait.

If I have face to face therapy, where will I be seen?  Do I have to travel to head office in Ilkeston?

No. We aim to provide a service that is easily accessible and local to where you live or work.  We have a number of such venues across the city and county.

Are there any age limits to access the service?

To be offered an assessment appointment you need to be over 16 years old. There is no upper age limit. If you are under 16, please speak to your GP about other services available for you.

Do you provide interpreters?

Yes.  If we are informed at referral that an interpreter is required, we will provide one free of charge.

Is there disability access?

The majority of our venues have disability access.  If you inform the administration team when booking your appointment that disability access is required, you will be offered an appointment at an appropriate venue.

I take anti-depressant medication; will that prevent me from accessing therapy?

No. The evidence shows that medication and therapy can work well together to help with people’s difficulties.

What type of help is available?

At the end of your initial assessment, you can discuss with the therapist which type of therapy may be of most benefit to you.  Options include: workshops and courses; telephone based facilitated self-help; computerised cognitive behavioural therapy packages; face-to-face individual counselling and cognitive behavioural therapy; couples counselling; psychosexual therapy; mindfulness based cognitive therapy and eye movement desensitisation (EMDR).  

Is everything I say kept confidentially?

Everything you say within your therapy session will be kept confidentially, unless you say anything that indicates that you are a serious risk to yourself or others, or divulge information that other people are at risk of harm.  In these circumstances we would break confidentiality to help to safeguard yourself and other people. 

Can I choose the gender of my therapist?

You may state a preference for the gender of your therapist.  Please mention this at referral.  Whilst we will strive to meet people’s specific preferences/requests, on occasion this may mean a slightly longer wait or a further travel to your appointments.

What if I can’t make an appointment?

If you are unable to attend your appointment please let us know as soon as possible on 0300 123 0542.  Our admin team will inform your therapist who will contact you.

I need to talk to someone now.  I can’t wait for my appointment.

Talking Mental Health Derbyshire is predominantly a planned treatment service for anxiety and depression, and does not offer a facility for crisis support. Should you feel that you need to speak to someone urgently, we recommend that you contact your GP surgery and speak to the duty doctor.  If your GP surgery is closed, the following organisations may be able to offer you support:

NHS: 111

Focusline: 0800 027 2127

Supportline: 01708 765 200

Samaritans: 116 123

        

What if I want to request a change of therapist?

Should you feel that your therapist, or type of therapy is not right for you at this time, if possible, please discuss this in the first instance with your current therapist.  If you do not feel able to do this, please contact the service on 0300 123 0542 and tell them that you would like to talk to someone about changing therapist.  Our administration team will arrange for a member of our team to discuss other individualised treatment options with you.

How common is it to request help?

The service is in very high demand.  Between March 2009-2012 one million people accessed an IAPT service in England.  Last year, our service received 11,000 referrals.

I am unhappy with the service I have received, how do I make a complaint?

The team at Talking Mental Health Derbyshire strive to ensure that you receive a quality service throughout your time with us.  However, if you are not completely satisfied with the service you received please email us your comments and suggestions for improvement to: talking@derbyshcft.nhs.uk

If you would prefer to speak to one of the management team, please telephone 0300 123 0542.

For further advice and support in making a complaint, please contact the Patient Experience Team by: telephone on 0800 027 2128 or 01332 623751; email patientexperience@derbyshcft.nhs.uk; or post: Patient Experience Team, Derbyshire Healthcare NHS Foundation Trust, Bramble House, Kingsway Site, Derby, DE22 3LZ. 

CAMHS:

Child and Adolescent Mental Health Services (CAMHS), provide a range of support and therapy for under 18's experiencing emotional, behavioural and/or mental health problems.

Care programme approach (CPA):

A careplan in secondary health services that co-ordinates some peoples complex and/or long term mental health care. People with a care plan should have a care co-ordinator, such as a social worker or community psychiatric nurse and receive regular reviews.

Clinical Psychologist: 

A professional that may work in both hospitals and community mental health teams (CMHT). Their work involves assessing a persons mental health needs and undertaking psychological therapies with individuals and groups.

CMHT: 

A community mental health team (CMHT) consists of mental health professionals such as: Psychiatrists, Psychologists, Social Workers, Community Psychiatric Nurses and Occupational Therapists, who work together to help people recover from mental illness. The CMHT may also be known as “Pathfinder” or the “Recovery Team”.

Cognitive:

Cognitive is a collective name for the thoughts we have and how we think.

CPN:

A Community Psychiatric Nurse (CPN) supports people with mental health difficulties, who are living in the community, through difficult periods of their illness. A CPN can often be a person’s keyworker.

Crisis resolution team: 

A service to help support people at times of crisis to remain in their own home, instead of admission to hospital.

IAPT service:

The Improving Access to Psychological Therapies (IAPT) programme (www.iapt.nhs.uk) supports the frontline NHS in implementing National Institute for Health and Clinical Excellence (NICE www.nice.org.uk) guidelines to improve mental wellbeing for people experiencing depression and anxiety.

Mental illness: 

A state of mind where the day to day functioning of a person is significantly impaired, or is placed at risk due to unrealistic beliefs, ideas and behaviours of the state of mind and usually requires the help of a secondary care specialist team to provide medication and treatment.

Mental wellbeing:

There are many different definitions of mental wellbeing but they generally include areas such as: life satisfaction, optimism, self esteem, mastery, feeling in control, having a purpose in life, a sense of belonging and having the ability to cope with the stressors of every day living. It is normal to feel happy when something positive happens to you, to feel sad or angry when a bad event occurs, or scared and anxious if you are dealing with something worrying. Part of ensuring good ‘mental health and wellbeing’ is recognising that it is natural to feel different emotions, but also knowing when you perhaps need some help in managing them.

Multi-disciplinary team: 

A Team made up of professionals from both health and social care.

Primary care mental health service:

Mental health and therapy services provided by front line professionals within the community. These services are usually easily accessible, often IAPT (Improving Access to Psychological Therapies) therapy services.

Psychiatrist:

Psychiatry is a medical field concerned with the diagnosis, treatment and prevention of mental health conditions. A doctor who works in psychiatry is called a psychiatrist. Psychiatrists must be medically qualified doctors who have chosen to specialise in psychiatry. This means that they can prescribe medication as well as recommend other forms of treatment.

Psychosis:

Psychosis is used to describe mental health problems that stop a person from thinking clearly, telling the difference between reality and their imagination and acting in a usual way. The 2 main symptoms of psychosis are: hallucinations and delusions. Hallucinations are where a person hears, sees (and in some cases smells) things that are not really there, a common hallucination is when people hear voices in their head. Delusions are where a person believes things, that when examined rationally, are obviously untrue.

Secondary care mental health service:

Often known as community mental health teams (CMHT), these are mental health services provided by specialists who generally do not have first contact with patients e.g. psychiatrists, clinical psychologists, community psychiatric nurses (CPN), social workers and occupational therapists. People are usually required to see a primary care provider, such as a GP, for a referral before they can access secondary care.

SSRI:

Selective serotonin reuptake inhibitors (SSRIs) are a type of medication used to treat depression and some anxiety disorders. They work by boosting levels of a substance called serotonin in the brain, which helps to improve mood.

Please note we are not an emergency service. If you feel you are at risk of harming yourself or other people, please follow the link below...
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