Category Archives: Therapy Research

Online or Face-to-Face?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Let me start with something that may surprise you:

Online/telephone work is as effective as face-to-face, according to the research. Is online/telephone work just the same as face-to-face then? – it does have a different feel. It can move slower sometimes, or faster sometimes. It can feel more intense, or less intense, at different times. Some clients can talk about issues over the phone/video more easily than face to face, and for some it’s the other way around.  So, the feel is different, but it works just as well for most people.

 

Most clients are pleasantly surprised at how well online and telephone counselling works for them, actually. To be honest, I have always preferred working face to face (although I started my counselling life as a telephone volunteer), and I prefer using video conferencing to a phone call – particularly now that smartphones can do everything. I have used all the methods for many years now, and I am well used to them.

The choice of a therapist is very difficult, because there are so many available.  Of course you will know that, whether you are looking for an online or face-to-face therapist it’s important to find a therapist that

  • you get on with
  • you can come to feel comfortable and relaxed with
  • who is competent and professional.

 

So how do you choose from the tens of thousands available?

Firstly, I do think that the best way to begin is to search professional directories for therapists in your own area. Why your own area? Your circumstances may change, and it’s then possible to move to face-to-face work if you want to, without having to start again with someone new.  So I suspect we would use online or telephone counselling during the times when we can’t meet in person – say if we think we might be infectious. I am open to creative solutions too – for instance I have had clients sit in their cars in front of my window, and talk on the phone to me while we nod to each other (fortunately my driveway is suitable for this).

Another advantage of working with someone in your area is that it is easier to make a connection with someone who has some shared experience with you – living in the same country is a good start! It can be a little difficult, for instance, having a deep conversation with another English speaking person from a different country, as the meanings of words, and the organisations of society are subtly different.

Using a professional directory means that the work of checking the therapist is qualified and experienced has already been done for you. For instance, I have chosen to advertise on the BACP website (my professional body), Counselling-Directory (I like their layout), and the BUPA Providers online website. (Spoiler alert, they all say the same thing, more or less – which is no bad thing).

Coming to feel a real connection when talking with your therapist is the number one predictor that your therapy will be successful. That comes as a surprise to most people, who think that face to face therapy must be better than the alternatives, or that one type of therapy must be intrinsically better than another.

Of course, when you are working online, some of that feeling comfortable and relaxed is down to you – a comfy quiet chair, privacy, a cup of tea, and decent phone or internet reception.

I think I can get a “feel” for a particular therapist by reading their website, however my wife would always want to speak to someone before making up her mind. It’s important that you find your own way. In my own practice, I find I get on very well with most people (surprise, surprise, I suspect that’s true of all good therapists, and anyone who is genuinely interested in hearing what the other person has to say), and very few clients have come to me since 1995 and just not got on with me. I don’t do trial sessions as such, but if a private client doesn’t want to continue after the first session, I refund all money received and am pleased to do it, – and as I say, it’s maybe happens once or twice a year. Take a look at the First Appointment page (link) if you need more details on that.

 

The Benefits of Practising Gratitude

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Paul Mills, a professor from the University of California in San Diego, is the lead author of an article on the practice of Gratitude, and its effects on physical health and emotional wellbeing.
I have thought for some time that because – for obvious evolutionary reasons – the body is hardwired to prioritise danger and other bad stuff that happens or might happen to us, that we need to find a way to restore some balance by consciously remembering the good stuff, the stuff we can be grateful for.


It is particularly important for anyone who suffers from periodic episodes of depression, that when we feel “up” we make lists – the longer the better – of the good stuff, so that we have something to buoy us up when we feel “down.” The practice is also vital for those who are torn apart by their self-critical inner voices. I’ve prepared a leaflet detailing the practice for those clients,  but here some general information:

Now, when things are bad, we may think, quite naturally, that there is nothing to be grateful for, but AT THE VERY LEAST we can be grateful that things aren’t even worse. I may feel like an incompetent, unattractive idiot who doesn’t deserve to have any friends, but I can be grateful that not everyone agrees with me! And we can usually do a lot better than that minimal and rather grudging example of gratitude, with practice.

I’m not asking you to lie to yourself. I’m asking you to treat yourself as if you were a person you need to care about.

And as with everything, exercising makes Gratitude stronger.

The practice of gratitude is easy to explain: you get a small notebook and pencil, and place it by your bed. At really stressful times its a good idea to carry it around with you, actually. Every night when you get into bed and are ready to go to sleep, you open the book and, thinking back over the day, write down just three things that you are grateful for, as if you were your own loving friend. These items must be written as positive statements, so you phrase them without using not, never, don’t, etc. So, for example, instead of saying my leg didn’t ache so badly today, you would say that my leg felt better today. Instead of saying that I didn’t feel so depressed today, you say I felt a little lighter today. If it’s difficult for you to think of three things, then spend a few minutes reading back what you have written in your notebook already, and you will recall something suitable. If you have faith, you can think of it as the practice of counting your blessings from a loving God.

Don’t expect instant results. It takes time for your brain to respond to this new, and initially difficult, way of thinking.

Gratitude practice activates the mammalian care-giving system which releases feel-good chemicals in our bodies (oxytocin and intrinsic opiates) and allows you to be self-compassionate, to deprogram the ingrained thinking habits, to feel much better.

By offering support and kindness to ourselves, we find that the body responds by feeling better.

And it has been shown to achieve a lot more for the body than “just” allowing it to feel better. Research using brain scans shows that after three months practice the medial prefrontal cortex has become much more sensitive, which helps to explains the steadily increasing effects of Gratitude practice that you will notice.

But Mills’ article talks about the physical effects too: “better mood, better sleep, less fatigue and lower levels of inflammatory biomarkers related to cardiac health.” The study involved 186 men and women who had been diagnosed with asymptomatic (Stage B – structural damage but no symptoms) heart failure for at least three months.
“We found that those patients who kept gratitude journals for those eight weeks showed reductions in circulating levels of several important inflammatory biomarkers, as well as an increase in heart rate variability while they wrote. Improved heart rate variability is considered a measure of reduced cardiac risk,” said Mills. “It seems that a more grateful heart is indeed a more healthy heart, and that gratitude journaling is an easy way to support cardiac health.”
Wow!
The full study is published by the American Psychological Association here (link to pdf)

I originally published this article in January 2017, but have updated and renamed it as new research is reported.

How Do My Results Compare With IAPT / NHS Therapy?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

(Spoiler alert – very well!)

This essay came about because of two things happening around the same time.

Firstly, I was questioned as to whether private therapy was good value compared to the NHS – “The NHS has got to be doing it cheaper, hasn’t it!” was what was said to me. And there certainly wasn’t a question mark at the end of her sentence.

I looked it up, as to be honest I thought it would be around my charge of £30 to £60 per hour session.

I was rather annoyed and disgusted to discover that it costed £95 a session for “low intensity work,” and around £175 for “high intensity.” I can deliver either.

But never mind the cost, what about the quality, was my next thought…..

 

The second thing that happened was that a blog I follow (which looks at the application of statistics to therapy, amongst other things)  published an article on the measured recoveries made by clients given therapy in the NHS. It’s here(link).

Quite frankly I found the results shocking.

So will you, and I reproduce the bare bones of the NHS/IAPT results below .

For comparison,  I have worked out my own matching statistics, and show those in blue, together with some thoughts on the discrepancies.

It is recognised that the primary characteristic of a high-quality counsellor/psychotherapist is the ability to enable clients to maintain engagement, i.e. to help them to keep coming until they have what they need. This can be measured by:

A. The proportion of those entering therapy who have a managed/planned ending. In my service, it is 82%, compared with the NHS at 58%.

B. The proportion of clients who have had a managed ending that show demonstrable improvement (using recognised psychological tests). In my service it is 98%, compared with the NHS at 51%, and of course the NHS is starting from a lower percentage anyway (51% of 58%, rather than my 98% of 82%).

That’s the bottom line really, but if you want a further breakdown, I’ve put some of the calculations below.

Why is the difference so stark? – Well, here are a few guesses.

  • The NHS/IAPT controls what therapies are available there, and how they are practised – the process is carefully “manualised” and there is little flexibility in the approach.
  • The whole idea of “low intensity” and “high intensity” therapy seems to me to be missing both the point, and the research, actually.
  • With me, my approach is tailored differently for every client. A psychiatrist that one of my client’s sees occasionally said that he felt that I was delivering “A Bespoke Service.” Unsurprisingly, I liked that.
  • Although I do do some pro-bono work, client’s have to be able to pay for my services, and that does mean that I get a greater level of readiness and commitment, and ability to engage with the world.
  • The NHS is all about seeing as many patients as they can, regardless of staff readiness and morale (sorry, but it’s true, and it isn’t the fault of individual therapists). I try my best to put people off from coming if they are not ready, I really do NOT want to see someone who isn’t ready to work with me.
  • I run my life around the delivery of a high quality service, including lots of meditation, down-time, reading, learning, and no late nights, excess alcohol, etc etc. I didn’t become a therapist as a career move, I became a therapist because it was very clear to those in the volunteer service I was helping at, and clear to the therapists I attended in my own personal therapy, that I had a natural ability to do it well, and the commitment to do the required training.

==========================

More Detailed Statistics Follow (for the Strong-Willed Only):-

  1. The journey from referral – 30% of IAPT referrals don’t enter treatment [I’m afraid I have no way of capturing this data for my own clients, as I rarely hear from people who decide to go elsewhere,  or nowhere.]
  2. The journey from entering therapy – 45% of IAPT clients that enter therapy don’t complete. [17% of my clients do not complete a course of six sessions,  or where they have decided to have more than six sessions then cancel what turns out to be their last session.  In these cases, having no closing data from testing, I cannot say definitely whether the client has met the standards for significant improvement or recovery. In some cases, I think it likely that the client feels that the process is not helpful to them, but decide not to talk to me about it and thereby come to a managed ending.. But some also leave suddenly,  having made good progress,  because they find it difficult to do endings,  or because they intend to return at some point, but haven’t needed to so far.]
  3. The outcome at therapy ending for all clients – 53% of IAPT clients do NOT achieve  recovery [the lower the number the better for this one. I use the CORE-OM test, an internationally recognised test for assessing risk, health, improvement and recovery. My percentage of completing clients who do NOT achieve recovery is 18%.]
  4. The outcome at therapy ending for clients that were at case level at the start – 51% of those clients achieve recovery (reach a point on psychological tests which are below the scores of a clinical population) in IAPT therapy [for my clients,  83% achieve recovery, and 98% have measured significant improvement in their symptoms. For my clients the main limiting factor is the budget in these cases. Often their employer will only pay for six or eight sessions and the client is would have to pay for further sessions with me once this number has been reached. These clients may well go on to other agencies – I often recommend local or online resources to clients who have finished but who would benefit from further sessions .]

What’s here:

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Received wisdom is that every website should have a blog. Mine contains (see on the right under “From David’s Blog):

  • musings about therapy, clients, counsellors, and society
  • answers to questions that I’ve been asked
  • if I’m taken ill, or there’s another reason why I can’t be reached, then I’ll try and post a notice here.  (so it would be a good idea for clients to tick the box below “Notify me of new posts by email.”)

 

Suggestions for additions (and subtractions) welcome.

Playing N.I.C.E.

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

NICE, the National Institute for Health and Care Excellence, has come up with another set of guidelines on mental health. Why is this important? Because if NICE recommend a treatment, it gets used as a matter of course, and if they don’t, it doesn’t.

The problem is that Mental Health is very hard to assess. Very hard indeed. And NICE are not doing a good job at assessing the different methods of delivering talking therapy..

In the area of health generally, the standard of proof that NICE requires is the “double blind randomised trial.” In brief, this is where neither the patient nor the doctor knows whether the patient is being treated, and neither do they know what they might be treating the patient with. This is good, because it stops the doctor from putting his own bias onto whatever results s/he is collecting.

Of course, this kind of research is quite impossible to carry out in the field of mental health. How can a counsellor not know whether or not he is counselling a client, for instance? Success in counselling depends on the relationship between counsellor and client, and that means often (shudder from NICE) the results come from asking the clients’ opinions. Good lord, how would the NHS function if effectiveness and quality was measured by the patients. Mmmmmmmmmmmmmmmm.

So NICE is going to prefer the type of therapy that can generate statistics closest to the double blind model. By it’s nature, CBT is easier than others to collect that kind of data. NICE, therefore, seemed to have been of the opinion that CBT was the only talking therapy that is proven to work, as that was the only type to have generated the statistics they considered reliable..

Gradually, NICE has been dragged kicking and screaming to the realisation that other methods of talking therapy, and indeed other methods of undertaking valid research, might just work as well in the treatment of, say, depression. However CBT has maintained it’s place as the first line treatment, the one most recommended, in the current guidelines.

At last we can get to the point: the research clearly shows that other talking therapies are at least as effective as CBT. It’s just that NICE are wary of looking at research that doesn’t have that humanity-excluding double blind methodology. And recent research shows that counselling delivered better results than CBT in fewer sessions. Add to this the huge number of trained counsellors who don’t want to work to a CBT model, myself included, and you could cure the massive problem with access to mental health services overnight. It would be cheaper too, per course of treatment.

Incidentally, the photo is of Nice, France. It has nothing to do with this article at all, but looks like it would be a nice place to recover from almost anything. Anyone who wishes to pay for me to undertake the research personally, get in touch.

A Leaflet about Depression

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

For some time now I have felt the need to write my own leaflet on the holistic approaches which are very helpful for depressed clients. I say clients, because becoming a client is certainly the most effective item of self-help a depressed person can do. Along with the therapy, I suggest researched self-care topics in this leaflet that are very likely to help speed and maintain your recovery. It’s value-for-money (VFM), really – if you don’t do the self-care, you will likely end up being in therapy a lot longer.

Reading a leaflet is more VFM than spending lots of time in the session, too, writing the stuff down when quite often your mind is pre-occupied. It can be used as a reference at home, and to support you when you have recovered. Each item has a clear evidence base in depression.

You can give the leaflet to people around you who want to help and be supportive, and several of the items , e.g. diet, will allow them to do just that.

The leaflet got quite large quite quickly!- too large to put on here, and too large to read in one sitting. I think I covered all the main points, though, in eight pages. Here is the self-care checklist that I put at the end of the leaflet, as a quick reminder, to be looked at every week by my clients – if you are depressed, how are you doing?

Checklist. Mark yourself out of ten as you progress with these ideas.

Be kind!

Becoming aware of when my brain starts to brood/ruminate?

Remembering to laugh at the critical inner voice?

Counting my blessings before going to sleep?

Practising mindfulness/meditation every day?

Going to therapy?

Watching and choosing what I eat?

Working on my own hidden anger?

Exercising in the open air?

How sociable and friendly have I been?

Have I done things that I used to enjoy doing?

Amusing myself with a funny book, film or TV show?

Have I congratulated myself for what I have done of the list above?

Each topic on my leaflet, reflected very briefly in the questions above, has been researched in it’s own right and shown to have a positive benefit on depressed clients.

How Does Psychotherapy and Counselling Work?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

The important thing is that the research shows quite clearly that it does work.
Oh, I can give you half a dozen theories, that’s one advantage of having an MA, but I quite like the following explanation:
It’s a special kind of conversation where two people get to know one person (you) better. While we both get to know you better, many of the problems in living that caused you to attend seem to resolve, or fall away, and be seen in a different light.
Sometimes missing life-skills can be identified, and we can agree on coaching to rectify these gaps in skills, such as deep relaxation, or assertiveness.

Or we can just agree it’s magic, and let it go at that!

(if you still want a more scientific explanation, here’s one – link – that’s pretty close)

Therapy is Cost-Effective

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Here’s a good subject to start the blog off on the revamped website.

A few years ago (2009) I came across an interesting bit of research. Personally, I have no doubt it’s accurate. Here’s an extract:

Research by the University of Warwick and the University of Manchester finds that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money.
Chris Boyce of the University of Warwick and Alex Wood of the University of Manchester compared large data sets where 1000s of people had reported on their well-being. They then looked at how well-being changed due to therapy compared to getting sudden increases in income, such as through lottery wins or pay rises. They found that a 4 month course of psychological therapy had a large effect on well-being. They then showed that the increase in well-being from an £800 course of therapy was so large that it would take a pay rise of over £25,000 to achieve an equivalent increase in well-being. The research therefore demonstrates that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money.
Governments pursue economic growth in the belief that it will raise the well-being of its citizens. However, the research suggests that more money only leads to tiny increases in happiness and is an inefficient way to increase the happiness of a population. This research suggests that if policy makers were concerned about improving well-being they would be better off increasing the access and availability of mental health care as opposed to increasing economic growth

A fuller description of the research is still up on the Warwick University website. That would be four lots of six sessions I suspect, today. You can do a great deal of work in that time.

Actually clients have told me that having a significant amount of therapy actually helped them make more money as well – promotions at work, greater self-confidence, that sort of thing. Sort of having your cake and eating it too, I suppose.