What is Hypno-psychotherapy?

Psychotherapy

Psychology is the study of human behaviour. It seeks to look at the motivational drives within an individual and offer an explanation to the behaviour that is demonstrated.

Psychotherapy is the use and application of psychological knowledge to help people understand themselves and begin to make appropriate changes, or to be comfortable with who they are.

Psychotherapy has several different theoretical models that have developed over time, the most commonly known being psycho-analysis. The therapy that I practise uses some of the best ideas from these differing schools of thought in order to help people achieve not only a rapid rate of improvement but also a lasting one. It has its basis in a cognitive–analytical model that seeks to look at the process behind thought, and understand how it has developed, and of course how to change negative thought processes into positive ones.

Hypnosis

Hypnosis is a very effective method of treatment. It is a state of altered consciousness with increased and heightened awareness, which is often accompanied by deep relaxation; this in itself can be beneficial. Contrary to popular belief it does not involve becoming unconscious and has nothing to do with sleep.

Hypnosis cannot be forced upon people, but it is a state which people allow themselves to enter.

It is important to understand that, during hypnosis, people cannot be forced to do things that they would choose not to do. Hypnosis or "trance" as it is often referred to is similar to the experience of day dreaming, when you lose a sense of time and may without thought continue a task that routinely requires concentration, such as driving from one place to another but not actually remembering the journey. This is an example of an altered state of consciousness that we experience every day of our lives.

What is Hypno-psychotherapy?

Hypno-psychotherapy is the practice of psychotherapy with applied hypnosis being the primary approach. The United Kingdom Council for Psychotherapy, the lead body for the provision of Psychotherapy in the United Kingdom, recognises the practice of hypno-psychotherapy.

Both hypnotherapy and hypno-psychotherapy utilise hypnosis in a therapeutic form, however an individual that only practises as a hypnotherapist may not have undertaken training in psychotherapeutic theory and practice.

For therapists to be able to register with United Kingdom Council for Psychotherapy requires an extensive programme of 4 years training.

Short courses of study that are readily available may give an insight into the techniques and practice of hypnosis, but they do not in themselves enable the practitioner to be able to address all forms of presenting problems.

It is strongly advised that anyone seeking any form of therapy investigates the qualifications and registrations of the practitioners they approach for treatment.

A United Kingdom Council for Psychotherapy registered therapist will always provide information relating to their qualifications and registrations if requested.

Ian Wharmby is a United Kingdom Council for Psychotherapy Registered Psychotherapist and Clinical Hypnotherapist and Nurse Adviser in Occupational Health. Ian's psychotherapy and hypnotherapy practice is based at the Liverpool Counselling and Psychotherapy Centre in Rodney Street, internationally renowned for its medical excellence. Visit Ian's psychotherapy, hypnotherapy and counselling in Liverpool, Wirral and Merseyside [http://www.ianwharmby.co.uk] website, which was designed by [http://www.webstarcreations.co.uk]Liverpool, Wirral and Merseyside web design.

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Who's Who In Mental Health Service - GPs, Psychiatrists, Psychologists, CPNs And Allied Therapists

When a person is experiencing psychological or emotional difficulties (hereafter called “mental health problems”), they may well attend their GP. The GP will interview them and based on the nature and severity of the persons symptoms may either recommend treatment himself or refer the person on to a specialist. There can seem a bewildering array of such specialists, all with rather similar titles, and one can wonder as to why they’ve been referred to one specialist rather than another. In this article I give an outline of the qualifications, roles and typical working styles of these specialists. This may be of interest to anyone who is about to, or already seeing, these specialists.

The General Practitioner

Although not a mental health specialist, the GP is a common first contact for those with mental health problems. A GP is a doctor who possesses a medical degree (usually a five-year course) and has completed a one-year “pre-registration” period in a general hospital (six-months on a surgical ward and six-months on a medical ward as a “junior house officer”). Following this a GP has completed a number of six-month placements in various hospital-based specialities – typical choices include obstetrics and gynaecology, paediatrics, psychiatry and/or general medicine. Finally, a year is spent in general practice as a “GP registrar” under the supervision of a senior GP. During this period, most doctors will take examinations to obtain the professional qualification of the Royal College of General Practitioners (“Member of the Royal College of General Practitioners”, or MRCGP). Others qualifications, such as diplomas in child health, may also be obtained.

The GP is thus a doctor with a wide range of skills and experience, able to recognise and treat a multitude of conditions. Of course the necessity of this wide range of experience places limits on the depth of knowledge and skills that they can acquire. Therefore, if a patient’s condition is rare or, complicated, or particularly severe and requiring hospital-based treatment, then they will refer that patient on to a specialist.

Focusing on mental health problems it will be noted that whilst the majority of GP’s have completed a six-month placement in psychiatry, such a placement is not compulsory for GP’s. However, mental health problems are a common reason for attending the GP and, subsequently, GP’s tend to acquire a lot of experience “on the job”.

Most GP’s feel able to diagnose and treat the common mental health problems such as depression and anxiety. The treatments will typically consist of prescribing medication (such as antidepressants or anxiolytics) in the first instance. If these are ineffective, alternative medication may be tried, or they may refer the patient to a specialist. GP’s are more likely to refer a patient to a specialist immediately if their condition is severe, or they are suicidal, or they are experiencing “psychotic” symptoms such as hallucinations and delusions.

The Psychiatrist

This is a fully qualified doctor (possessing a medical degree plus one year pre-registration year in general hospital) who has specialised in the diagnosis and treatment of mental health problems. Most psychiatrists commence their psychiatric training immediately following their pre-registration year and so have limited experience in other areas of physical illness (although some have trained as GP’s and then switched to psychiatry at a later date). Psychiatric training typically consists of a three-year “basic” training followed by a three year “specialist training”. During basic training, the doctor (as a “Senior House Officer” or SHO) undertakes six-month placements in a variety of psychiatric specialities taken from a list such as; General Adult Psychiatry, Old Age Psychiatry (Psychogeriatrics), Child and Family Psychiatry, Forensic Psychiatry (the diagnosis and treatment of mentally ill offenders), Learning Disabilities and the Psychiatry of Addictions. During basic training, the doctor takes examinations to obtain the professional qualification of the Royal College of Psychiatrists (“Member of the Royal College of Psychiatrists” or MRCPsych).

After obtaining this qualification, the doctor undertakes a further three-year specialist-training placement as a “Specialist Registrar” or SpR. At this point the doctor chooses which area of psychiatry to specialise in – General Adult Psychiatry, Old Age Psychiatry etc – and his placements are selected appropriately. There are no further examinations, and following successful completion of this three-year period, the doctor receives a “Certificate of Completion of Specialist Training” or CCST. He can now be appointed as a Consultant Psychiatrist.

The above is a typical career path for a psychiatrist. However, there are an increasing number of job titles out with the SHO-SpR-Consultant rubric. These include such titles as “Staff Grade Psychiatrist” and “Associate Specialist in Psychiatry”. The doctors with these titles have varying qualifications and degrees of experience. Some may possess the MRCPsych but not the CCST (typically, these are the Associate Specialists); others may possess neither or only part of the MRCPsych (many Staff Grades).

Psychiatrists of any level or job title will have significant experience in the diagnosis and treatment of people with mental health difficulties, and all (unless themselves a consultant) will be supervised by a consultant.

Psychiatrists have particular skill in the diagnosis of mental health problems, and will generally be able to provide a more detailed diagnosis (i.e. what the condition is) and prognosis (i.e. how the condition changes over time and responds to treatment) than a GP. The psychiatrist is also in a better position to access other mental health specialists (such as Psychologists and Community Psychiatric Nurses or CPNs) when needed. They also have access to inpatient and day patient services for those with severe mental health problems.

The mainstay of treatment by a psychiatrist is, like with GP’s, medication. However, they will be more experienced and confident in prescribing from the entire range of psychiatric medications – some medications (such as the antipsychotic Clozapine) are only available under psychiatric supervision and others (such as the mood-stabiliser Lithium) are rarely prescribed by GP’s without consulting a psychiatrist first.

A psychiatrist, as a rule, does not offer “talking treatments” such as psychotherapy, cognitive therapy or counselling. The latter may be available “in-house” at the GP surgery – some surgeries employ a counsellor to whom they can refer directly.
Psychologists and allied mental health staff typically provide the more intensive talking therapies. Some senior mental health nurses and CPNs will have been trained in specific talking therapies. It is to a Psychologist or a trained nurse that a psychiatrist will refer a patient for talking therapy. These therapies are suitable for certain conditions and not for others – generally, conditions such as Schizophrenia and psychosis are less appropriate for these therapies than the less severe and more common conditions such as depression, anxiety, post-traumatic stress disorder, phobia(s) and addictions. In many cases, a patient will be prescribed both medication and a talking therapy – thus they may be seen by both a therapist and a psychiatrist over the course of their treatment.

The Psychologist

A qualified clinical psychologist is educated and trained to an impressive degree. In addition to a basic degree in Psychology (a three year course) they will also have completed a PhD (“Doctor of Philosophy” or “Doctorate”) – a further three-year course involving innovative and independent research in some aspect of psychology. They will also be formally trained in the assessment and treatment of psychological conditions, although with a more “psychological” slant than that of psychiatrists. Psychologists do not prescribe medication. They are able to offer a wide range of talking therapies to patients, although they typically specialise and become expert in one particular style of therapy. The therapies a particular psychologist will offer may vary from a colleague, but will usually be classifiable under the title of Psychotherapy (e.g. Analytic Psychotherapy, Transactional Analysis, Emotive therapy, Narrative therapy etc) or Cognitive Therapy (e.g. Cognitive Behavioural Therapy (CBT) or Neuro-Linguistic Programming (NLP) etc).

The Community Psychiatric Nurse (CPN)

These are mental health trained nurses that work in the community. They will have completed a two or three year training programme in mental health nursing – this leads to either a diploma or a degree, depending on the specific course. They are not usually “general trained”, meaning their experience of physical illness will be limited. Following completion of the course they will have spent a variable amount of time in placements on an inpatient psychiatric unit – this time can range from twelve months to several years. They can then apply to be a CPN – they are required to show a good knowledge and significant experience of mental health problems before being appointed.

CPNs are attached to Community Mental Health Teams and work closely with psychiatrists, psychologists and other staff. They offer support, advice and monitoring of patients in the community, usually visiting them at home. They can liaise with other mental health staff on behalf of the patient and investigate other support networks available (such as the mental health charities).

Some CPNs will be formally trained in one or more “talking therapies”, usually a cognitive therapy such as CBT (see “Allied Therapists” below).

“Allied” Therapists

Many “talking therapies” are offered by non-psychologists – for example, mental health nurses and mental health occupational therapists can undertake a training course in a cognitive therapy like CBT. After successful completion of the course, the nurse will be qualified and able to offer CBT to patients. The length and intensity of these courses can vary dramatically, depending on the type of therapy and the establishment providing the course. Some are intensive, full-time one or two week courses; others are part-time and can extend over months and years. Perhaps a typical course will be one or two days a week for two to three months. Formal educational qualifications are not necessary to undertake these courses, and they are open to “lay” people with little or no experience of the NHS mental health services. Of course this is not necessarily a problem - it may even be considered a positive point!

Some of those therapists thus qualified will offer their skills as part of their work in the NHS – for instance, a nurse or CPN may offer cognitive therapy to a patient that has been referred by a psychiatrist. Unfortunately this is relatively rare at the moment, presumably due to the reluctance of the NHS to pay for such training for their staff. As a result these therapies are more accessible on a private basis.

Summary

An individual with psychological difficulties will normally attend their GP in the first instance. The GP will usually have encountered similar problems with other patients and can offer a diagnosis and appropriate treatment. If the condition is unusual or particularly severe, the GP can refer the patient to a psychiatrist. The psychiatrist is able to access a wider range of treatments (medications and hospital care) and can, if necessary, recruit other mental health professionals to help the patient. This system perhaps works best with the severely mentally ill such as those with psychotic symptoms or who are suicidal.

The Mental Health Services in the NHS are generally less well suited to those with psychological problems of a less severe nature – the moderately depressed, the anxious, the phobic etc. The availability of “talking therapies” is limited in the NHS, with long waiting lists or even no provision at all in some areas. This appears to be due both to the cost of training staff appropriately and the time-intensive nature of these therapies.

For those with such conditions, the main option is to seek help outside the NHS. There are some voluntary organisations that offer free counselling for specific problems such as bereavement or marital/relationship difficulties, but more intensive therapies (such as CBT or NLP) are typically fee based. Your GP or local Community Mental Health Team may be able to recommend a local private therapist.

Karen is a mental health occupational therapist whose background is working in the NHS mental-health system. Karen practices privately in Hertfordshire, where she employs NLP and Hypnotherapy techniques to help people with emotional, psychological and behavioural problems. For more information about NLP, Herts visit http://www.karenhastings.co.uk

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Mental Health Services

Mental health problems are common with around 25% of the population believed to be suffering from some form of mental health problem at any point in time. Anyone suffering from a mental health problem can access proper treatment and most who do seek help will make a complete recovery but unfortunately, there are still people who are afraid of admitting that they cannot cope or that they need help and will suffer unnecessary mental distress due to lack of understanding about their illness or awareness of what help is available. So what mental health services are available to anyone suffering from mental illness?

Doctor

The first point of contact is your doctor. They will be able to make a full assessment of your symptoms and your physical and mental health in general as well as take into consideration any other factors involved including any family history of mental illness in order to make an accurate diagnosis because an accurate diagnosis is essential if the right help and assistance is to be offered. For most people, a simple visit to the doctor may be all that is required to put them on the road to recovery.

However, your doctor might feel that you could also benefit from other mental health services so once he or she has made a diagnosis they will be able to start you on a suitable treatment programme which could include medication and/or referral to other professionals or specialists in the community mental health team as required, for example, social workers, psychologists, psychiatrists, various types of counsellors or therapists and so on.

The Community Mental Health Team (CMHT)

It may be that you require specialist skills in order to help you cope with your mental illness and as one person couldn't conceivably be an expert in every single area, you could be referred to someone in the community mental health team. The community mental health team will vary depending on which area that you live, some may be attached to a hospital or work from a doctors surgery and others could possibly have their own clinic in a separate building but typically, they consist of professionals such as psychiatrists, psychiatric nurses who may also be trained to deal with specific problems or behaviours, clinical psychologists, occupational therapists, social workers, and various other therapists and counsellors.

It is quite likely that one person will be appointed as your key worker and will be liaising with you on a regular basis and visiting you at home. This person could be a social worker, a nurse, some type of therapist or quite commonly, a community psychiatric nurse or CPN.

The CPN will assess your progress on a regular basis, will identify and help you deal with any problems you might have and put you in touch with others who can help, they will monitor your mediation and any effects of that medication and will generally offer support. They will work closely with other professionals in the team so that everyone is aware of any particular issues or challenges that need to be dealt with. The CMHT will also regularly inform your doctor about your progress, your medication and any other issues involved in your case.

It might be that you need help from other professionals. For example, an occupational therapist can help you regain some independence in your life if you are suffering from any disabilities, they can help you to do things for yourself and improve your confidence in areas such as dressing, washing and other practical skills. Social workers can help with many social problems such as housing needs, financial issues and maybe parenting or child care challenges. Basically, the Community Mental Health Team enables you to access the right kind of help from professionals who are trained in a specific area.

Hospital

It might be that you need to spend some time in hospital to get over a particularly difficult episode of mental illness or where it is considered appropriate but this decision is not taken lightly. Hospitals can offer safety and protection and many people will voluntarily admit themselves to hospital in order to get the right assistance and support. However, there are also compulsory admissions made under the Mental Health Act in order to protect the person themselves or those around them. For some people, the thought of admission to hospital can be frightening but it is important to remember that a stay in hospital can be a lifesaver and hospitals are there to help and are better equipped to deal with particularly severe cases of mental illness.

More support

Family and friends can be instrumental in helping someone who is suffering from mental health problems to progress and regain control of their lives and as such are an extremely important part of any support network. There are also numerous other agencies, support organisations, and charities offering help to people suffering from various mental health problems. Some will also tackle issues related to mental health by raising awareness in the community and others can provide information, advice and support to people who are affected by mental health problems in their family. You can ask your doctor or mental health professional what other assistance is available in your area.

Depression and anxiety are serious mental health conditions that can strike anyone at anytime. For more information about depression and self help come and visit http://www.fightingdepression.co.uk

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