Psychological Health at Workby Dr Christopher C Ridgeway
The major therapeutic methods
Therapy can take many forms and there is no ‘one size fits all’. Many therapists may well use a number of therapies, tailoring their choice of method(s) to suit the client’s particular needs, perhaps combining hypnotherapy with CBT, for example.
Therapy generally includes explorations of how the client (ill person) thinks about how they feel about particular situations (for example, driving at night/accidents); changing the way they think (their underlying negative belief) will then influence their behaviour. The aim is to help the client to abandon unhelpful beliefs and behaviours. Therapy also includes ‘homework’, usually diaries recording thoughts, feelings and actions. Therapy is normally short, about six to ten sessions being the average. Some therapists will also provide skills training in relaxation and/or anger management and so on.
This therapy assumes that the person (patient) has the answer to the psychological problems within themselves. The therapist’s major stance is to trust the ‘client’ and to facilitate their capacity to generate their own solution to their problem.
A longer form of therapy, this is often used when the cause of mental illness is thought to be a result of early life experiences. The focus is generally on the client’s childhood, and its current influence on depression, anxiety or phobias. The basis of the therapeutic approach is generally the work of Freud, Jung or their followers.
The methods used can include ‘free association’, where clients spontaneously say what is in their thoughts at the time. The therapist/analyst sits behind the client’s head and does not intervene, but notes what is said.
Interpretations will be made by the therapist/analyst. For example, where the client relates their dreams, the therapist/analyst may provide interpretations to the ‘client’.
Sessions can be up to four times per week and can last for years. Currently, most longer-term therapy is likely to be referred to as psychodynamic. Some therapists use analytical methods as part of a process similar to CBT, which they call CAT – Cognitive Analytic Therapy (this, like CBT, is a much shorter form of therapy).
Other therapies that managers might encounter include
- Hypnotherapy, where the client is facilitated to relax, making them more open to suggestion; it is frequently used to treat anxiety, phobias, stress and addictions
- Transactional analysis, which focuses on the clients’ state as a child, parent or adult, in particular situations (see the topic on Transactional Analysis)
- Gestalt therapy, where the focus is on the here and now, with the client being facilitated to become more aware and in touch with the aspects of themselves that have been ‘suppressed’.
There are many other forms of therapy. New ones, such as EMDR, emerge regularly. Where managers are unsure, they should ask their professional advisors or search the web.
Mental health professionals
Apart from the therapists mentioned above, others who could be involved in the provision of treatment include
- Mental Health or Community Psychiatric Nurses (CPNs)
- Community Psychiatric Nurse Administrators – some monitor medication and some provide counselling and or relaxation training, mostly at home
- Mental Health Nurses, who work closely with doctors in hospitals and, like CPNs, administer medication; additionally, they provide day-to-day care within the hospital
- Mental Health Social Workers can be based in day centres, hospitals or mental health centres; they usually work in multi-disciplinary teams and provide counselling, family advice and benefits advice, as well as arranging for day care and so on
- Occupational Therapists – these tend to teach clients/patients cooking, shopping, self care, communication skills and leisure skills. They liaise with social workers, CPNs and others involved.
There are other therapists whom managers might encounter when they seek information about absent staff with psychological health problems. These include day care and residential home staff, approved social workers and complementary therapists.
When gathering evidence about a psychologically distressed person, you should seek to get reports from all the professionals working with the absent member of staff. Managers need to be aware that ‘unreasonable’ behaviour could lead to claims for damages. By liaising with professionals, you will be able to gather information that will help you to avoid such a claim. You might, for example, seek guidance as to what course of action you might take to aid the ill person’s recovery. You may also find that it is advisable to change the organisation’s processes, practices and procedures in order to reduce the likelihood of future psychological damage to staff. (For more, see the topic on Disability, Reasonable adjustments.)
Psychiatrists are medically qualified and have specialist training in psychological medicine. They are mainly based in hospitals, though many also undertake private consultations. Some operate purely as private consultants.
Many people who consult doctors and are subsequently diagnosed with a psychological illness will be referred to a psychiatrist. They will usually see a junior doctor or a House/Senior House Officer.
Those who follow the private route will see a psychiatrist consultant: either one in full-time private practice or an NHS consultant undertaking part-time private work.
The psychiatrist’s major treatment mode is drugs. If a therapeutic intervention is prescribed, this is sometimes undertaken by the psychiatrist, but more usually the psychiatrist will recommend a clinical/counselling psychologist or a psychotherapist.
Many psychologically ill people’s initial treatment will be a combination of drug therapy and psychotherapy.
Where cognitive dysfunction is suffered, a clinical psychologist will probably be instructed to carry out psychometric testing to determine the specific nature of the problem.