# MHApps Take Control – Talking Therapies – Importance Of Talking In Recovery And Wellbeing

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- Talking Therapies “Even as pharmacological treatments improved the management of symptoms, those with self-experience of schizophrenia and other psychoses attending mental health services, often reported a profound sense of alienation in their interactions with mental health services.

- People attending services, struggling with their experiences, could not find anyone to help them articulate their experience and try to make sense of what was happening to them.

- Within a biologically oriented treatment paradigm, the particular individual experience of psychosis is not of clinical significance, being simply a manifestation of the illness process and therefore to be medicated away and hopefully forgotten as far as possible, rather than being integrated into the sense of self. Psychologists and psychotherapists were not, by and large, available within mental health services to people with a diagnosis of schizophrenia and requests for such were dismissed as inappropriate.
  In more recent years the biological model has been superseded by the bio-psycho-social model, and a multimodal approach to treatment, taking account of the biological, social and psychological dimensions of psychotic illness is now favoured (NICE, 2003, A.M.A., 1997). The development of a strong service user movement, of which Shine is a part, has provided practical support and, perhaps more important, validation, companionship and a voice to those experiencing mental health difficulties. The service user movement accords a high degree of importance to personal narratives, such as people’s personal accounts of their illness and journey towards recovery.
  This has provided an outlet for the articulation of feelings of personal alienation and invalidation of experience, which had unfortunately been part of many people’s experience of treatment services.
  The recovery movement or recovery approach to mental health, endorsed by A Vision for Change (2006) as a guiding philosophy for our mental health service, has provided an ideological framework for the development of user-friendly services.

- User-friendly services respect the individual’s experience, recognising that, while psychiatric diagnostic systems focus on similarities in clinical presentations, the personal experience of psychosis is an individual one and touches on the very essence of the self.

- Additionally, the development of cognitive behavioural treatment protocols, which have a good deal of success in tackling positive symptoms of psychosis, such as delusional thinking and auditory hallucinations, have also refocused attention on the value of working with the individual’s experience through some sort of “talk” therapy. These developments have been accompanied by a renewed interest in the development of new and better-targeted models of counselling/ psychotherapy and psychological therapy as part of treatment packages for psychosis. These models tend to draw on insights from psychotherapy and psychoanalysis, psychological theory, cognitive behavioural theory and family therapy. Interventions are grounded in a stress vulnerability model or its updated version the ‘stress vulnerabilitycognitive model’, and benefit from a deeper understanding of the nature of psychotic experience and of the phasic nature of schizophrenia. They are, therefore, better targeted and, the research suggests, more effective. These newer approaches require highly skilled and well-supervised practitioners with high levels of personal flexibility. Fenton (2000) talks about “the therapists capacity to ‘shift gear’ flexibly and change roles with all patients based on changing circumstances, always holding the goal of helping the patient accept, learn about and self-manage what may be a chronic and devastating illness” (Dr. Anne Byrne Lynch, Principal Psychologist, HSE. Talking about Talking Therapies. Schizophrenia Ireland)
  “Traditionally, talking therapies have been considered to have little role as an intervention for psychosis. The prevailing view has been that psychosis is purely a medical issue. Service users and their carers often ask for counseling frequently, wanting to talk about their distress, their problems, their psychotic experiences. They are often informed that counselling would not be good for them, indeed that it would be likely to cause a deterioration in their condition. They are often told that therapy may be considered well down the line, but in practice this rarely occurs. In my opinion, this is a misguided view, one which needs to be revisited. The obvious benefits of medication, particularly in the acute stages, do not negate the role of talking therapies.”

- Talking therapies can play an important role in enabling the person to live well, understanding themselves and their symptoms, to work towards living the life they want to live, a safe place and space to begin rebuilding their sense of self and interacting more effectively with the world.” (Terry Lynch. Talking about Talking Therapies. Schizophrenia Ireland)

- “I would far prefer to learn about myself and what makes me tick, especially, what makes me tick the wrong way and how to fix it. Who knows you best, but yourself, what you need to know is how to deal with other people assertively, but illness and hospital makes you lose confidence and belief in yourself and your own abilities.” (Brendan. Talking about Talking Therapies. Schizophrenia Ireland)
- The process of counselling and psychotherapy Psychotherapy is usually carried out in the same location weekly, and at an agreed time. Once weekly is the most usual arrangement, but frequency depends on the client’s needs. If a client is in crisis, additional sessions may be required.
  The type and length of the psychotherapeutic process is highly individualised, one size does not fit all. The process usually depends on the nature of the problems presented, the dynamic between therapist and client, and other variables. Counselling and psychotherapy can be accessed in different forms. These include individual therapy, couple counselling/therapy, family therapy and group therapy. These therapies and other psychological therapies may be available through primary healthcare (local general practice or primary care team), through mental health services, voluntary agencies and private practitioners. The type of therapy a person needs is based on the particular problem that they are trying to address. For the person with marital problems, couples counselling might be recommended. If the concerns are based on childhood experiences then psychoanalysis or psychoanalytic psychotherapy may be an appropriate intervention to seek out.
  The type and level of therapeutic intervention depends on the nature of the psychological problem, including:
  · how long someone has tried to deal with the issue, possibly without success
  · the impact on daily functioning
  · ineffective coping strategies
  · the degree of distress being experienced
  Counselling and psychotherapy explores these issues through listening and talking methods that consider change and personal developmental needs.
  Positive progress in psychotherapy is dependent on the willingness and determination of the individual to achieve change. It can mean trying out new things and new ways of being that will be challenging. Some things that may impact on the effectiveness of psychotherapy would include:
  · how ready the person is to engage in the process
  · how difficult the situation is
  · what other supports are available to the person
  · the ability of the client to reflect
  The full text of this document is available on www.shineonline.ie/publications. It includes information on understanding the process of talking therapies and how to make the right choice for you.

- Many people with self-experience and their families speak of the need for counselling or psychotherapy to help them make sense of their experiences. Gaining access to talking therapies is difficult in Ireland for a number of reasons. Most therapists practice outside the HSE and thus, there is a financial barrier. Many mental health professionals believe that only a few specific therapies can benefit people with significant mental ill health. Very few recognise the importance of such support for family members.

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