Psychosis (young people)
Talking and other therapies for young people experiencing psychosis
Talking therapies include one-to-one (in person, over a telephone or online) and group sessions with a person qualified in a kind of psychotherapy or counselling. Therapy could be:
- more structured sessions based on varying ideas of psychotherapy (such as Cognitive Behavioural Therapy – CBT)
- less structured and provide a space to just talk about things like feelings
- group therapies with other young people, or
- family therapy.
Some people we spoke to had been offered talking therapies for depression, low mood and anxiety during their childhood or when they first experienced psychosis. People also mentioned a range of different talking therapies including CBT, Dialectical Behaviour Therapy and counselling.
- Cognitive Behaviour Therapy (CBT) is a form of psychotherapy that gives people techniques to manage and change their response to thoughts and feelings.
- Dialectical Behaviour Therapy (DBT) is a form of CBT that aims to help people accept themselves, deal with intense emotions and improve skills in relating to others.
CBT and DBT usually involve a short number of very structured sessions (6 to 8 typically) and can be done in groups, whereas counselling (sometimes called psychotherapy) can continue for longer and provides a space for people to talk on a one to one basis with a trained professional to explore their deeper thoughts and feelings. You can read more about different types of talking therapy on the Mind website.
Getting a referral
Talking therapies were arranged through a school or college nurse, GP, Child and Adolescent Mental Health Services, Early Intervention in Psychosis team or a charity such as Mind. Getting a referral can take some time. Some people mentioned long waiting lists and missed opportunities due to staff errors. Emily has been on a waiting list for DBT for 2 years. Ruby never received her appointment letter for talking therapy because her dad had told her to leave home and she was “sofa surfing” when it was sent out. But Becky was seen quickly once her referral was processed. The benefits of talking therapies
Talking therapies often include learning practical strategies for managing mental health as well as the opportunity to gain greater understanding of, and control over, thoughts, feelings and distressing experiences. Sometimes just having an opportunity to share feelings with somebody can be a relief. Joe learnt to think about his voices differently during CBT sessions. Now he understands the voices better and no longer sees them as the “big, scary voices appearing out of the dark”.Group therapies provide an opportunity to talk and hear about (and learn from) the experiences of other young people. For some people we interviewed this was the most helpful because they felt less alone. However, if the person’s experiences were quite different to others attending the group, it could leave them feeling worse. Factors affecting the experience of talking therapy
The timing of the therapy, and level of expertise of the therapist was important to people we spoke to. Some who had therapy very early on in their experience of psychosis said they didn’t benefit from it. Counselling that young people received through their school in particular tended not to be specialised enough. Andrew X and Tariq both had counselling in school after bullying led to a breakdown. Andrew X felt he needed more than just talking and would have preferred to have been referred for help from a psychiatrist. Tariq found the techniques that the counsellor suggested to help him deal with his anxiety, such as mindful breathing, didn’t help and he began to feel suicidal.
Well-meaning support from people in the community who did not have the training or skill to help with psychosis was also sometimes unhelpful. Lucy’s church assigned her a pastoral care worker who was a trained counsellor, but who didn’t have the skill to help with psychosis, and she didn’t feel the sessions helped her.
But those who had a lot of experience of psychosis could find talking therapies helped them to get some better understanding of why it was happening, and this was helpful.mindfulness, and a few had posted blogs or video diaries online. Many also engaged in peer support work, often as volunteers, and found talking to others with similar experiences helped. Some talked about the benefits of talking with friends and family or other mental health workers such as their carer. Luke finds his Social worker is able to understand him as a person and prefers talking to him than to his psychiatrist. Dominic has a great relationship with staff at his local Mind centre and can call there and just have a “rant” if something is on his mind.Finding the right therapist was very important. A few people mentioned the difference between therapists who were following a “process” and those who tailored the sessions to the individual. For Andrew X the best therapists just allowed him to talk and used CBT to help with what came up. Finding a therapist who seemed to genuinely care about them was also important for some people and this could take time. Some of the people we spoke to didn’t find talking therapies helped them or didn’t want to try it. A few felt that counselling always focused on the negative and could make things worse, while others were worried it would bring up unpleasant memories. Chapman, who is seeking asylum in the UK, was offered counselling but turned it down because he was concerned it might “bring back stuff” from his past in Zimbabwe which he wanted to forget. Andrew X thinks only being offered 6 sessions of CBT can be damaging because it opens a “Pandora's box” but doesn’t allow time to deal with things properly. Fran doesn’t like counselling and thinks therapists “invent problems” which aren’t there. However, she has found books on CBT helpful in giving her practical tools (see below). People sometimes found other ways to tell their story or work through things: such as art or dance therapy, journal writing, writing poetry or using techniques such as