Cognitive analytic therapy (CAT)
Cognitive behaviour therapy (CBT)
Interpersonal therapy (IPT)
Dialectic behaviour therapy (DBT)
Psychoanalytic/psychodynamic Psychotherapy
Talking therapies
Self-help groups and support groups
Cognitive Analytic Therapy (CAT)
How does it work?
You can understand something about CAT from its title.
‘Cognitive’ tells you that it is about utilising you ability to reflect and think about your feelings, behaviours and assumptions.
‘Analytic’ tells you that the therapy will help you to explore factors that may be contributing to your behaviour and feelings. This will include factors that you may not already be aware of and events that occurred in your past.
CAT seeks to identify where a problem has come from and how it has evolved, situating problems within your history and experiences. Using this bigger picture as a basis for understanding the here and now, CAT looks critically at what may have become habitual and ineffective coping strategies; why do you uses these coping strategies? How have they helped in the past? Are they helping now? The aim in doing this is to identify links between situations, emotions and coping strategies that combine to form what CAT terms ‘procedures’. From here you will work with the therapist to challenge these procedures and develop alternative coping strategies based upon your strengths and resources.
What can I expect sessions to be like?
Your first appointment is likely to be a 90 minute assessment. You will be asked about what drove you to seek help and about your personal and family history. Notes will be taken during the session and you will be given a copy of the assessment. The purpose of the assessment is to establish whether CAT is right for you.
If CAT is deemed right for you the therapist will take you through a process of reformulation, recognition and revision.
Reformulation involves you telling the therapist about your history and describing what is going on in the present. Together, you and the therapist will produce a ‘reformulation document’ of writing and diagrams that describe your past and present and the relationships between them. Particular attention will be paid to your relationships with friends and family, with the therapist and with yourself.
Recognition is about identifying harmful behaviours and relationships. You will work with the therapist to find patterns in your behaviour and relationships and to understand how they relate to events and experiences identified during reformulation.
Revision. You will be given homework tasks intended to help you recognise and analyse harmful behaviours and relationships.
Cognitive Behaviour Therapy (CBT)
How does it work?
You can understand something about CBT from its title.
“Cognitive” tells you that it focuses on your thoughts, beliefs and attitudes and the ways in which these impact on your mood and emotions.
“Behaviour” indicates that it looks at the ways in which we behave and, most importantly, how these behaviours are linked to our thoughts, beliefs, attitudes and emotions.
CBT is based on the belief that problems do not arise from particular events but rather from the ways in which we interpret those events. For example, a friend walks past you on the street but does not say hello; she was lost in her thoughts and did not see you. In and of itself, this is not a problem Everyone gets distracted from time to time and it should not be a cause for upset. It becomes a problem if you start to think things like ‘She didn’t say hello because she doesn’t like me. I have done something to upset her. I am a bad person.’ Negative thoughts, such as these, can become deeply entrenched within your mind leading thinking patterns or ‘dysfunctional assumptions’ that form rules for living. In other words, the thought is repeated so regularly that it pops into your head automatically, not only when a friend ignores you, but in other situations too.
CBT aims to help you to identify and challenge your thinking patterns: What beliefs, emotions and attitude underlie your thought? Can the thought be justified based on past experiences? This process will assist you in rationalising your thought process and will highlight alternative ways of interpreting situations.
Alongside this CBT will help you to understand the ways in which your thinking patterns are linked to your behaviour. It will encourage you to look critically at these behaviours; Does the behaviour help me to deal with situations or emotions? Is there a better way of coping with situation and emotions? Through this process you will be helped to develop alternative coping strategies based upon your particular strengths and resources.
Finally, CBT will equip you with a set of tools and principles that will help you to control and positively change thinking patterns and apply newly discovered coping strategies to a range of situations.
What can I expect sessions to be like?
Before you start CBT you will undergo an assessment. You will be asked to complete a questionnaire about your symptoms and will then be asked a series of questions about the problems you are experiencing and what drove you to seek help. You will also be asked about your personal history including information about your family, childhood, education, work and past and present relationships. The assessment will conclude with a discussion as to whether you and the therapist think CBT is the right course of action.
CBT is structured around specific problems and goals. At the start of each session you will work with the therapist to identify a specific problem that you want to focus on during the session and in the coming week. You will also decide on a goal that you would like to work towards. The problem and goal identified will form the basis to the content of the session and the homework set between sessions. The therapist is likely to take notes during the session and will encourage you to do the same. The therapist may also use a white board or flip chart to demonstrate ideas, sometimes in diagrammatic form. Sessions may be tape recorded, as a way of reinforcing and reminding you of what has been learnt during a session.
Homework forms an important component of CBT. It links sessions together, highlights problems and difficulties and helps you apply techniques discussed during sessions. At the start of therapy homework is likely to focus on identifying and recording incidents and emotions. As you progress, homework will be used as an opportunity for you to test out techniques discussed in sessions.
Each session will have time set aside to discuss any barriers or problems that you faced when addressing a specific problem and what parts of the previous session and homework you found helped or hindered your progress. Conclusions drawn from this discussion will form the basis to a revised plan of action.
Initially, the therapist will decide on the structure and content of the sessions. As your confidence grows and you discover what is and isn’t helpful you take more control over the session content, deciding what you want to work on each week and how you are going to go about reaching a specific goal.
At points during your CBT programme you should be asked how you feel the therapy is progressing. Your therapist should be skilled at adapting the ideas behind CBT to your specific situation and problems. If you feel that this is not be achieved it is important that you tell them this so that any misunderstandings can be addressed.
It is rare that all your problems will be solved during the course of treatment. More commonly, skills learnt during sessions form the foundations to continuing development. In support of this CBT is often followed up with some form of self-help that aims to consolidate your skills and motivate you to continue to look critically at automatic thoughts and utilise alternative coping mechanisms discovered during therapy.
Interpersonal psychotherapy (IPT)
How does it work?
ITP focuses on the ways in which your current relationships may be leading to psychological stress and vice versa. It will help you to recognise relationship problems and identify how these might be related to other issues including harmful behaviour and low mood. Relationship problems usually fall into one of the following three areas:
- Interpersonal disputes including unresolved arguments or agreements and unmet expectations.
- Role transitions, where relationships are affected by sudden changes in circumstances such as starting university.
- Grief or loss.
- Interpersonal sensitivity, which is related to difficulties starting or maintaining relationships.
What can I expect sessions to be like?
The first session will be spent discussing important relationships in your life and how these relationships may be affecting your current behaviour and mood. Together with your therapist you will develop an Interpersonal Inventory outlining your key relationships, the strengths and problems with these relationships and the people who may be able to assist you with your recovery. From this you will decide on which relationships you are going to focus on.
Once you have had a few sessions you and your therapist will develop an outline plan for the remaining sessions. Focus will be on discussing and making positive changes to your main interpersonal problems. You will:
- Look critically at your current relationships and the ways in which they trigger emotions and behaviours.
- Work towards improving communication skills.
- Discuss your emotional reactions to interpersonal problems and the positive changes that you can make to improve these.
You will be offered the opportunity to invite someone with whom you have a close relationship with to one/a number of the sessions. The aim of this is to help that person to understand what you are going through and support you in your recovery.
As you reach the end of your therapy programme, time should be spent discussing how you feel about the therapy, including the progress you have made. It is also important that you look at the skills and support networks you have developed during therapy and consider how these may be used if problems occur in the future.
Dialectical Behaviour Therapy (DBT)
How does it work?
DBT focuses on changing behaviours in the here and now. It does not look to the past for reasons behind specific behaviours but rather looks at current barriers to therapy and change.
It works by balancing acceptance and change. Acceptance techniques validate coping mechanisms, recognising that although they may not be in your best interest they have, and may continue to, serve a purpose. Change is encouraged by presenting you with alternative interpretations of situations and varying perspectives on the world.
What can I expect session to be like?
Each weekly session will last between 50 and 60 minutes. Goals are set at the beginning of each session and form the focus of that session. These goals will be individual to you, based upon your problems, fears and aspirations for change. Between sessions you will be asked to record your emotions and actions. These will inform the goals set and work carried out in each session. The record of your emotions and behaviours will also form the basis to ‘behavioural solution analysis’. This looks at what caused a specific incident of harmful behaviour to occur, what you were feeling before, during and after the behaviour and what consequences the behaviour had. Once this information has been established you will work together with the therapist to establish how you might prevent the incident from happening again and to help you to identify realistic alternative coping strategies.
You are likely to be taken through 4 stages.
Stage 1 – gaining control over your actions.
This includes addressing barriers to therapy and change, reducing harmful behaviours and addressing factors, outside of your eating disorder that may be impacting on your quality of life (such as depression, problematic relationships, work/study related stress).
Stage 2 – understanding and dealing with emotions.
Once you have reached a point at which you feel to have control over your eating disorder, DBT will shift its focus towards your emotional well-being. The aim of stage 2 is to increase your understanding and acceptance of both positive and negative emotions so that you can tolerate negative emotions and embrace and fully experience positive emotions.
Stage 3 – day to day living.
Stage three focuses on the issues that you may face in daily life; things such as being invited out for dinner or being faced with a high stress situation that may cause you to revert back to old, harmful ways of coping. The aim is to help you live a fulfilling life, complete with joy and sadness, achievement and disappointment, moments of calm and moments of anxiety.
Stage 4 – moving on.
The final stage is about moving on; addressing any lasting concerns and fears, especially those relating to your experience of an eating disorder.
You may not have to complete all 4 stages. Your therapist will discuss your DBT with you and you will decide together what is best for you.
In addition to individual therapy you may be offered group sessions aimed at teaching you skills that will help you to deal with difficult situations. Skills include:
- Distress tolerance, which focuses on dealing with crises.
- Interpersonal effectiveness that will help you to be more assertive when asking for help and when declining to perform tasks or participate in activities at request of others.
- Emotional regulation that will help you to understand and claim greater control over intense emotions.
- Mindfulness, which teaches you skills to help you to focus your attention on the here and now rather than on past negative experiences or worries about the future.
As with the individual therapy, you are likely to be given tasks to complete between sessions. These will help you to apply what you have learnt during the session and will throw up any issues that can be addressed in the following session.
Psychoanalytic/psychodynamic psychotherapy
How does it work?
Psychoanalytic psychotherapy is a form of talking therapy and will therefore involve you talking to a professional psychotherapist who is trained to listen and respond sensitively to your problems. The aim of Psychoanalytic psychotherapy is to help you to understand and challenge conscious and unconscious thoughts and assumptions that get expressed in our relationships and behaviour.
Reaching an understanding of your unconscious thoughts and the effect that they have on your conscious thoughts and actions is, in part, achieved by looking critically at your relationship with the therapist. By offering you a safe place to explore you emotions, thoughts, hopes, fears and experiences, unconscious thought patterns and assumptions will become apparent in your relationship with the therapist. Through this process you will gradually become more aware of unconscious thoughts, where these thoughts have originated from and how they are affecting your current behaviour, relationships and emotional wellbeing.
What can I expect sessions to be like?
Before you start Psychoanalytic psychotherapy you will be given a questionnaire to complete. This will provide the psychotherapist with information about you and your experiences for use in the initial assessment interview.
The assessment interview will last between one and two hours. It is an opportunity for you to experience what Psychoanalytic psychotherapy is like so that you and your therapist can make in informed decision as to whether it is right for you. If it is deemed as the right course of action the therapist will discuss with you the different treatment options and when, how often and for how long you would like to meet each week.
Psychoanalytic psychotherapy is non-directive. That is, sessions are not structured or planned as is the case with cognitive or dialectic therapies, and the therapist is not there to offer advice or suggest solutions to you problems. Rather, you direct each session according to how you are feeling at the time and the therapist listens to what you have to say, offering their understanding and suggesting possible unconscious influences to your experiences or problems. Providing you are open to the therapist’s point of view, are willing to tolerate uncertainty and desire a greater level of self-understanding, this process will help you to think differently about your life and find your own solutions to problems.
Talking therapies
There are a number of different types of talking therapy, all of which share the common aim of helping you to understand yourself and your problems better. They offer you an opportunity to talk about problems you are facing and how and why these problems are impacting on your emotional well-being and behaviour.
Counselling
The main role of a counsellor is to listen to your problems and give you the time and space needed to work through difficult emotions. Through this process it is hoped that you will draw your own conclusions as to the best way to move forward.
Psychotherapy
Each psychotherapist will have their own approach to treatment that will impact on the focal point of discussions and the processes used to help you to overcome problems. Your therapist will describe his/her approach in more detail before starting sessions.
Whatever the approach, central to psychotherapy is helping you to understand why you are experiencing specific emotions and behaving in certain ways. This is achieved by talking about your experiences and how these experiences made your feel and behave. From here, you will work with the therapist to identify alternative ways of managing situations.
Self-help groups and support groups
Self-help groups
Self-help groups are non-professional groups run by and for people with a specific problem or condition. They can offer a safe place to discuss problems and fears with others who have been through similar experiences. Groups are there to provide mutual support and are often used as a place to share information and coping strategies relevant to a specific problem.
Self-help groups should be viewed as an addition to professional support, rather than as an alternative.
Support groups
Support groups are similar to self-help groups. They give you an opportunity to share and discuss your problems with others who have had similar experiences. The person who runs the session will have received training to do so but may also have had personal experience of an eating disorder. In some cases groups may be run by a professional. Support groups will help to combat feeling of isolation and may enable you to express and explore feelings and behaviours that you are reluctant to share with family, friends or professionals.