THE HAPPINESS DIRECTORY

How do you choose between the countless forms of therapy? Here is a guide to the paths to well-being
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PSYCHIATRY

Psychiatrists are trained in medicine and go on to specialise in psychiatry. They treat patients with severe mental disorders and may prescribe drugs and refer for clinical treatment, including residential care. Some psychiatrists also work as psychotherapists (qv).

PSYCHOANALYSIS

Based on the theories of Freud, that repressed childhood conflicts, if unresolved, manifest themselves in anxiety and depression in later life. The aim of psychoanalysis is to bring repressed feelings to a conscious level. It's a protracted process usually seen as suitable for severe personal distress. Between three and five sessions a week for up to five years is average. Psychoanalysis is not available on the NHS and costs approximately pounds 50 per hour.

! Institute of Psychoanalysis, 63 New Cavendish Street, London WlM 7RD (0171 580 4952).

Psychosynthesis: A form of psychoanalysis which distinguishes between a higher and a lower consciousness. The aim is to synthesise the two in the belief that the lower unconscious harbours repressed feelings and neuroses and our higher unconscious is our spiritual dimension. The belief is that unconnected these two "selves" can lead to psychological pain but merged people experience energy and well-being. Suitable for people with persistent low-level unhappiness. An initial six-week assessment period and then the time scale is agreed by therapist and client. Gaining recognition within the NHS but still mostly private. Cost pounds 10-pounds 40 per hour.

! Institute of Psychosynthesis, 65a Watford Way, London NW4 3AQ (0181 202 4525)

PSYCHOTHERAPY

A generic term, from the Greek words "soul" and "healing", for talking therapy in which the relationship with the therapist is central. Through this relationship, clients learn to see damaging patterns of behaviour and by experiencing feelings towards the therapist - a process known as transference - have the opportunity of resolving conflicts. There are many different types of psychotherapy including Freudian-based, humanistic and behavioural approaches. At best psychotherapy can make a considerable difference to how we feel and how we function but the same approach will not suit everyone. One caveat: this is an unregulated profession which means anybody can call themselves a therapist, but there is the United Kingdom Council for Psychotherapy with which reputable training institutes register.

! British Association of Psychotherapists, 37 Mapesbury Road, London, NW2 4HJ (0181 452 9823)

Personal Construct Therapy: A client's own perceptions and ideas are used to help them restructure the way they perceive themselves with the aim of bringing about a change in outlook. It is used for depression, addiction and personal issues. A fixed number of sessions is agreed. Can be available on NHS but mostly in the private sector. Costs from pounds 30 per hour.

! Centre for Personal Construct Psychology, The Sail Loft, Mulberry Quay, Falmouth, Cornwall TRll 3HD (01326 314871)

Analytic Psychotherapy: combines theories of psychoanalysis with psychotherapeutic practices. The relationship between the therapist and client is used to expose habitual and damaging patterns of behaviour, wishes and fears, and through self-understanding offers the chance of transformation. Seen as a less intense version of psychoanalysis. Average attendance is twice a week over two years. It can be had individually or in a group. Sometimes available on the NHS. Private fees between pounds 20-pounds 70 per session.

! Centre for Psychoanalytical Psycho-therapy, 99 Holmleigh Road, London N16 5QG (0181 800 8329)

Transpersonal Therapy: this word was adopted by Carl Jung in 1917 and has come to be known as an umbrella term for therapeutic and psychological approaches that share a spiritual view. Central to the theory is that life has purpose and meaning and the therapeutic quest is to find one's essential self and place within the collective unconscious which unites us.

! CCPE, Beauchamp Lodge, 2 Warwick Crescent, London W2 6NE (0171 266 3006)

Hypnotherapy: hypnotherapy is a form of psychotherapy and not a music hall act. A state of deep relaxation is achieved, which the client goes into voluntarily. In this state people are helped to re-live past traumas and reach long-repressed feelings so that they can be brought to the conscious level and explored. Hypnotherapy is not going to stop you smoking, being addicted to sex or whatever, but it will help you look at why you are doing it.

! The National Register of Hypnotherapists and Psychotherapists, 12 Cross Street, Nelson, Lancs BB9 7EN (01282 699378)

PSYCHOLOGY

Psychology is the study of the mind and of human behaviour. Psychologists undergo a three-year training in basic theory, then, in order to work in the NHS, a further clinical training. The following two therapeutic approaches are practised by psychologists and have been recognised as extremely effective, particularly in treating people who have eating disorders, phobias and depression. They are not suitable for people with severe personality disorders.

Behavioural Therapy: This is based on the idea that we have learnt to respond to our environmental experiences in a particular way - but in a way that may be harmful to our well-being. So specific goals are set for teaching new ways to respond. In a controlled situation, the problem is confronted and the person is helped to find a way to manage his or her fear. Appropriate behaviour is rewarded. This approach is particularly suitable for specific complaints like phobias and compulsive disorders.

Cognitive Therapy: The cognitive approach starts from the belief that we are capable of using reason to address a problem and find a solution. Cognitive therapy focuses on the way we think about ourselves and helps us to learn to identify, challenge and change dysfunctional automatic thoughts. This approach features in much short-term, goal-oriented therapy, but it can also be used for longer term treatments, for example with major depression. It is available on the NHS and privately.

! British Association for Behavioural and Cognitive Psychotherapies, Dept of Clinical Psychology, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ (0181 869 2325)

Cognitive Analytical Therapy: A variation of the above: this approach combines cognitive theory with psychotherapy (qv). The aim is to make use of a person's capacity for self-help and to give them skills to change their unhappy and destructive patterns. Thoughts and actions are linked to mental processes which are explored in the psychotherapeutic relationship. Can be done in a limited number of sessions, on average 16, one-to-one or in groups. It is available on the NHS.

! British Association of Cognitive Analytic Therapists, Munro Clinic, Guy's Hospital, London SE1 9RT (0171 955 4822)

The 12-Step Programmes: The first of these was Alcoholics Anonymous, but this method of treatment is now used with many other addictions from narcotics to food. It is a self-help plan and uses behavioural and cognitive techniques. People are encouraged to stop using their "substance of choice" and are advised on alternative behavioural strategies and ways of looking on the world. Addicts can be treated in residential private clinics which are expensive but which are also sometimes available on the NHS or through attending the nationwide network of self-help group meetings.

! Alcoholics Anonymous (will give contact numbers for "anonymous" groups dealing with other addictions) 01904 644026

HUMANISTIC AND HOLISTIC THERAPY

The term humanistic separates this approach from the analytic or the behavioural. Humanists believe it is within our power not to be neurotically tied to the past. For example, if we are depressed, we might be asked if the root could be anger, and then we would be encouraged to act out that anger in the safety of the therapeutic relationship. Humanistic therapies acknowledge psychoanalytic thought but most important is the holistic approach which works to release mental anguish through the body. The advantages of the humanistic approach is that it allows people use their creativity to address their problems, with psychodrama for example; the disadvantages are that people may open up dramatically and, if the therapist is inadequately trained, they may end up with emotional flooding which can feel very bad. Quick-fix therapies, as these are seen to be, encourage gurus and can often mislead people as to long term benefits. You are unlikely to find this on the NHS; pounds 30 is average for one hour.

Gestalt Therapy: Acting out, dream recall and other techniques are used to help people act out their conflicts and feelings and this is often done in a very active and physical way, for example pummelling cushions or shouting at objects representing the person you fear to confront in real life. Very powerful feelings often surface quickly and dramatically in the catharsis. Can be done in groups or individually with a therapist. Unlikely to be found on the NHS. Average cost pounds 30-pounds 35 per hour.

! Gestalt Centre, 64 Warwick Road, St Albans ALl 4DL (01727 864 806)

Bioenergetics: The work of Wilhelm Reich was the starting point for bioenergetics which holds that our bodies store our emotional history in the same way as our minds do. The therapy combines aspects of psychotherapy and physical exercises designed to release pent-up tensions and conflicts, physically and verbally. Considered effective for people suffering from stress, sexual and relationship difficulties and emotional trauma. Can be done in groups or individually. Not available on the NHS. Costs pounds 25-pounds 35 per hour.

! British Association of Analytical Body Psychotherapy, 47 Dean Court Road, Rottingdean, Brighton BN2 7DL (01273 303382)

Primal Therapy: This is based on the work of Arthur Janov, and the idea that certain behaviours result from suppressed primal frustrations and pains and that they then stay in the body as tensions and blocks which manifest as neuroses. The aim of primal therapy is to take you back to what is called the "primal scene" when the suppression took place so that the pains and frustrations can be articulated and "released". This is a very intensive process and can take many years with several sessions a week and practitioners expect to see profound change. Not available on the NHS. Cost pounds 30-pounds 40 per hour.

! London Association of Primal Psychotherapists, 18a Laurier Road, London NW5 1SH (0171 267 9616)

Rebirthing: when we are born there are often ambiguities or difficulties around the birth, either emotionally or physically. The baby is sensitive to this and, so the theory goes, it creates negative feelings of separateness which are repeated through life. By using breathing and reassurance techniques, the rebirthing therapist helps people "recreate" the feelings and offers the possibility of transforming them. There is no set timescale to the therapy, but 10 sessions is standard. Rebirthing is only available privately, and is difficult to find. No central body regulates or accredits practitioners, so proceed with care. Contact a healing therapy centre for information on practitioners or contact the National Register of Hypnotherapists (see left), as some hypnotherapists are also trained in rebirthing.

Autogenic Training: An anti-stress technique pioneered in Germany in the Twenties by Dr Johannes Schultz. It is based on a system of mental exercises learnt in a series of eight weekly lessons, and practised for a few minutes every day, designed to focus attention inwards in much the same way as a meditation. Can be done individually or in groups. Considered useful to de-stress people and for psychosomatic disorders. Limited availability on the NHS. Private fees are between pounds 100-pounds 180 for the full course.

! British Association for Autogenic Training and Therapy, Heath Cottage, Pitch Hill, Ewhurst, nr Cranleigh, Surrey GU6 7NP

Neuro-Linguistic Programming: the belief is that our mind has neurological pathways which account for our personalities. NLP de-constructs the personality by focusing on language and patterns of behaviour; people are helped to see the effect their behaviour has on others. Alternative strategies are offered. NLP is used in both clinical and commercial settings as part of management training courses.

! The Association of Neuro-Linguistic Programming, PO Box 78, Stourbridge DY8 2YP (01384 443935)

Creative Arts Psychotherapy: this uses the expressive arts such as art, drama, music and movement as vehicles for therapy. People are encouraged to express emotion through art which they cannot communicate verbally. Especially good for children and helpful in a wide range of problems such as depression and eating disorders. Individually or in groups and although it may be on offer within the NHS, this is usually confined to special needs cases. Privately costs pounds 20-pounds 40 per session.

! The Institute for Arts in Therapy and Education, The Windsor Centre, Windsor Street, London Nl 8QL (0171 704 2534)

Psychodrama: Aims to get us acting out inner conflicts and feelings, rather than just talking about them. This is done within a supportive, structured group. When the process is effective, emotions are unblocked; insight and catharsis are achieved.

! British Psychodrama Association, 8 Rahere Road, Cowley, Oxford OX4 3QG (01865 715055)

COUNSELLING

In counselling, the therapist reflects back to the client what they are saying in order to help them become aware of what it is they are thinking, feeling and saying. Then, with the help of the counsellor, the client can look at the problem in other ways and choose different solutions. Contrary to popular belief, counselling is concerned with exploring emotions rather than advice giving. There is some overlap between the talking therapies and counselling, the latter tends to focus more on specific life problems or short-term difficulties, whilst psychotherapy deals with more deep- seated personal issues. For problems such as marital and sexual difficulties, or life crises such as bereavement, there are often specialist counsellors available. Some GPs have counsellors attached to their surgeries.

It is important to be sure the counsellor you choose has had a thorough training, because counselling courses where the person ends up with a certificate of proficiency can last from years to just weeks. Counselling is an unregulated profession but the British Association for Counselling has a voluntary register of members. Voluntary agencies work on a donation scheme for fees and private scales range from pounds 15 to pounds 40 per hour.

! British Association for Counselling, 1 Regent Place, Rugby, Warwickshire CV21 2PJ (01788 550899); Relate, British Association for Sexual and Marital Therapy, PO Box 62, Sheffield S10 3TL; Cruse Bereavement Care, 126 Sheen Road, Richmond, Surrey TW9 1UR. Information line: 0181 940 4818; bereavement helpline: 0181 332 7227

Transactional Analysis: A form of group therapy developed by Eric Berne in the 1950s based on the idea of "social transactions". The belief is that everyone interacts with other people on three levels - the child, the parent and the adult; and this therapy explores how we make each other feel and how we respond. For example, every parent knows how their teenage child makes them feel and this feeling is archetypal and may emerge in all sorts of situations such as between husband and wife. Once people are aware of the games and roles they play, these patterns can be consciously changed. TA is effective for short-term counselling work over six sessions, but it is also used on a longer-term basis. It is offered on an individual, couple or group work basis and sessions range from pounds 20 to pounds 35 per hour.

! The Institute of Transactional Analysis, BM Box 4104, London WC1 3XX (0171 404 5011)

Family Therapy: based on the belief that many symptoms, problems and conflicts are linked to family relationships. Looking at the interactions between family members, how they communicate with each other, refer to each other, and what hidden messages seem to be there, can help each person look at what is going on and how they might change damaging ways of behaving. A particularly helpful kind of therapy when everyone is prepared to co- operate and the advantage is that in getting the whole family to look at its problems it removes the notion of individual blame. It has had considerable success with young anorexic girls. It is less successful when one or several members of a family have come reluctantly and are resistant to what goes on.

! The UK Association for Family Therapy, 18 Winnipeg Drive, Lakeside, Cardiff CF2 6ET (01222 753162); The Institute of Family Therapy, 43 New Cavendish Street, London W1M 7RG (0171 935 1651)

DRUGS

Drugs which cause a chemical change in the brain are available only on prescription. They may be used in conjunction with therapy - often cognitive or behavioural. There are often several types of drugs for one condition - and the doctor will choose whichever the patient seems to respond to and tolerate best.

Anti-Depressants: By far the most talked about anti-depressant, because of the enormous media hype it has had, is Prozac. This drug has been hailed by some as a panacea, as a happiness pill which can make even those who don't think they feel unhappy, transcend their normal state. Such claims anger doctors who see Prozac as an effective drug for depression and no more, and they point out it has only a two in three success rate, on a par with other anti-depressants. There is also a powerful anti-Prozac lobby of people who say it caused terrible and sometimes terrifying side effects.

The oldest anti-depressants are MAOIs (monoamine oxydase inhibitors) but these are rarely used unless a person cannot tolerate other kinds. More widely used are trycyclics - the most popular is Prothiaden. Recently developed anti-depressants are SSRIs (Selective Serotonin Re-uptake Inhibitors) of which Prozac is one. Even newer are SNRIs (Serotonin and Noradrenalin Uptake Inhibitors) and RIMAs (Reversible Inhibitors of Monoamine Oxydase). All these drugs have been found to lift mood and relieve depression.

Anti-depressants are sometimes prescribed for obsessive compulsive disorders, panic disorder, agoraphobia, other phobias and eating disorders because they seem to work better than tranquillisers.

There is no evidence that anti-depressants are addictive although people may become dependent on the feeling of well-being they bring and may find it hard to give them up if they don't address any underlying problems. The advantage to the newest types is that you cannot kill yourself with them, as you can with MAOIs and trycyclics.

Drugs for Anxiety: When we are anxious it is as if our life is on hold, is how Elizabeth Wilde McCormick, author of the book Breakdown (Optima) sees it, and she adds: "Every time our mind brings us back to the thought, collection of thoughts or object that we are anxious about... we feel taken over by this mysterious process called anxiety." Anxiety can become so severe that it can lead to panic attacks and there may be frightening symptoms such as sweating, palpitations, very fast heart rate, dizziness and so on. And anxiety can be self-perpetuating: when we are conscious of being anxious about something, merely thinking about it induces symptoms.

Benzodiazepines, of which the most famous is Valium, used to be prescribed for anxiety until the horrendous stories of how people had replaced anxiety for addiction with "mother's little helper". Research has shown that one in three people taking benzodiazepines becomes addicted and this can happen after four weeks of use. Now they are prescribed sparingly and rarely for long-term use.

Beta-blockers which are non-addictive can be found in the medicine cupboards of many public performers, speakers and communicators. They inhibit anxiety for a matter of hours and so tend to be used to keep anxiety at bay for the desired period, rather as we might use a painkiller to offset the beginning of a headache.

Sleeping Pills: Bad sleep can lead to anxiety and something to break the cycle of sleeplessness can be a great help. Temazepan, a benzodiazepine, is one of the most popular sleeping pills, and its great advantage is that it gives four hours' deep sleep without a hangover. But it is considered highly addictive and people taking it for as few as three nights consecutively have been found to get rebound insomnia. It tends to be recommended as an occasional emergency one-off dose to give a good night's sleep.

Drugs for Addictive and Compulsive Behaviour: The medical way of viewing of alcoholism is to divide it into alcohol dependence - a chemical addiction, which leads to withdrawal effects; and alcohol related problems such as cirrhosis, debt, criminal offences, binge drinking etc. For the alcohol dependence, drug therapy is sometimes used to help addicts come off and to prevent fits and DTs. Beta- blockers, tranquillisers or high doses of Vitamin B may be used very briefly to help sedate during come-down. This procedure should only be undertaken with medical supervision, as breaking the addiction abruptly can be dangerous.

For the alcohol-related problems, therapy or an Alcoholics Anonymous group will support the addict and help him or her to look at ways of dealing with the problems linked to their drinking, and assist them in rebuilding their lives.

! Compiled by Angela Neustatter, with additional research by Nicola Gibson

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