Some tips for getting the most from your therapist Revised and updates slides from a presentations m

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Some tips for getting the most from your
therapistRevised and updates slides from a
presentations made at the Anxiety Disorders
Conference, October 2002

• Paul M. Salkovskis, Maudsley Hospital Centre for
  Anxiety Disorders and Trauma, and Institute of
  Psychiatry,
• Kings College London, UK
• Please note Paul regrets that he is unable to
  deal with individual questions and queries. He is
  regularly available at service user conferences
  and webchats on OCDUK and NoMorePanic

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Getting the most from your therapist Why does it
matter?

• Previously, it didnt. It used to be simple you
  needed a decent human being
• A decent human being still helps, but treatments
  with very specific modes of action are now
  available
• First line Cognitive behavioural therapy
• Second line combination CBT and SRIs
• Anything else!!

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Basic requirements for a therapist.

• Someone you can trust or believe that you can
  come to trust
• Someone who can respect you, and you can respect
  in the same way
• Someone who knows how to help you to change
• Someone who knows how to avoid the most serious
  pitfalls
• Usually,this means someone who is trained
• Someone who is aware that psychological treatment
  is rapidly evolving

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At the heart of OCD.

• The sufferer feels responsible for things which
  they are not able to control
• Contact with professionals is an example of this
  problem

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Screen your therapist

• Training
• Specialist vs Generalist
• Experience
• Gender (where it matters)
• Preferred style of working
• Continuity of therapist
• Danger signs
• Seating (across desk is a bad sign)
• Doesnt like to be asked questions

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Types of therapist

• Cognitive-behavioural nurse therapist (formerly
  ENB 650)
• Psychiatrist
• Clinical Psychologist
• MH Nurse (including CPN)
• Occupational Therapist
• Counsellor
• Counselling Psychologist

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Useful web addresses

• www.babcp.com

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Questions to ask about your therapist

• What qualifications/experience do you have?
• Dont be impressed by titles
• Some letters after name are misleading
• Ask about specific OCD experience
• Trainees not necessarily a problem
• Less likely to be up themselves
• More likely to be up to date
• More likely to be up for it (enthusiastic)
• More likely to have supervision

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Likely quality of therapy

• Do you have specialist training in the
  psychological treatment of OCD?
• What kind of training?
• Do you receive therapy supervision? From whom?
• (Specialist, peer group, generalist)
• What kind of supervision?
• (verbal, video/audiotape)

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Therapy details Evidence Based Patient Choice

• Do you have a choice?
• What is the evidence for the options (pros and
  cons)
• What type of therapy is it?
• How long will it be?
• How long/regular are the sessions?
• Will it involved in vivo work?
• What involvement of others (partner, family etc)

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Getting the best out of your therapy preparation

• Time line and history of your OCD
• Be aware of things which you find difficult to
  discuss. Try to decide not to keep important
  secrets
• Writing things down can help, either as notes for
  youreself or to hand to therapist
• Ask for reading
• Do your own reading
• Try to make sure you are on time!!

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Therapy itself

• Remember
• You know more about your problem than your
  therapist
• You probably know more about OCD as well
• Therapists need your help but may not want to
  admit it.
• Try to be active and collaborative
• Ask if the sessions can be audiotaped
• May have to do this yourself
• Good tape recorder, external microphone
• Listen to the tapes and make notes!
• Ask questions

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Therapy itself

• Beware reassurance seeking. It will make things
  worse in the long run, and therapists often dont
  spot it.
• Dont be too kind to your therapist therapists
  have a self protecting bias which works against
  you and for them.
• Homework. Make sure that you are clear about why
  and how. If therapist forgets, remind them.
  Summarise both.
• Beware the pessimistic therapist. Most service
  users have enough pessimism for two, so a good
  dose of optimism is one of the things a good
  therapist can contribute

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Inpatient treatment

• In non-specialist units only accept this if it
  is for your own safety
• For OCD admission is only a geographical
  convenience in specialist units
• Alternative service delivery models
• Intensive outpatient treatment
• Non-traditional patterns of appointments (several
  long appointments tailored to your particular
  needs)

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When things go wrong

• Dont automatically accept the blame
• Ask about alternatives
• Referral to specialist services
• Second opinion
• Complaints

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Wrong treatment for OCD

• Psychoanalysis
• Most psychodynamic therapy
• Cognitive Analytic Therapy
• Silly medication (non SSRI or SRI)

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Complaints your right

• NHS formal procedure
• Discuss with therapist first (if you can if you
  cant then you are probably right to complain!)
• Seek local resolution
• Formal complaints write to trust complaints
  department
• Professional bodies
• BABCP
• BPS
• RCP

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Getting the most from our health service

• We need to persuade the NHS to do two things
• Recognise that generic counselling is
  insufficient for severe and persistent anxiety
  disorders and resource dissemination work
• Recognise the need for high quality tertiary care
  for severe and treatment refractory anxiety
  disorders and resource these appropriately,
  distribute them across the UK.

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Service users contribution to clinical services

• Help please?