What to expect
Assessment
Before therapy commences, an assessment appointment will be arranged. This is usually longer than a therapy session, or may span over two sessions, and gives you an opportunity to discuss your difficulties. Your therapist will ask you about any relevant background history, what triggered your difficulties, treatments you may have tried in the past, your goals for therapy and any current barriers that may get in the way of therapy (e.g. work commitments, holidays, other medical appointments etc.).
Safety is of paramount importance so we will also ask you questions relating to risk to yourself and to others.
In order to determine whether you are suitable for therapy and which psychological intervention would be most appropriate, we may ask you to fill out some questionnaires.
Formulation
After your assessment appointment(s), you and your therapist will start to use the information obtained about yourself to piece things together based on why your problems developed and what is currently maintaining them. Different psychological theories will help guide the formulation but in general we can piece together your difficulties based on:
Past Difficulties: These are the things that have happened to you in the past that may have made you more vulnerable to the problem. Risk factors may include how you were treated growing up, bullying, trauma, family history of similar difficulties, developmental issues. These factors may also not apply to you and it is okay if you are unable to think of any.
Triggers: These tend to be more recent experiences that triggered or started your current problems. Examples may be significant transitions (e.g. changing jobs/roles, retirement, separation, starting a family), the loss of a loved one, a traumatic event, a stressful job, a physical health issue. Some individuals report no triggers to their difficulties or feel that the way they have been feeling has been 'life-long'.
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Maintaining factors: These are the things that we do or think that typically keeps the problem going. For example, if you feel anxious and as a result, you avoid going out, your anxiety may well remain the same. This could be because you are not allowing your body to experience the anxiety and learn that it is okay to go out. Similarly, the way that you think about your problem could impact on your symptoms. For example, individuals who feel depressed may develop a certain type of thinking style, with regards to how they view themselves, others and the world, that keeps their mood low. Others may get very attached to certain negative thoughts or memories. It can be difficult to provide distance, allowing you to see your thoughts or memories as just that. Maintaining factors can even increase the amount of distress you experience or contribute to additional problems. For example, staying in because you are anxious could lead to social isolation as well. Thinking about something in a certain way may generalise to thinking about everything in that way leading to further distress.
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Strengths: Although therapy is primarily about talking through your difficulties, it is important during the formulation stage to highlight your strengths. These include the things you are good at, the support networks that you have around you and the things that keep you going (e.g. your children, spouse, pets, job etc). During therapy, we can draw upon these things as a way of supporting and motivating you to achieve your goals and live towards your values.
A free copy of the British Psychological Association's leaflet on "Understanding Formulation" can be downloaded here.
Treatment
Treatment consists of providing time-limited interventions that help you to deal with your difficulties more effectively. This may be about reducing symptoms of anxiety or increasing mood. This may be about acceptance of difficult emotions or physical health conditions. During therapy you will develop a better understanding of your difficulties (psychoeducation), strategies to help you manage your symptoms and how to reconnect with people and activities you value, thus improving well-being/functioning.
Interventions are based on evidence which is documented within professional guidelines such as the National Education for Scotland's Psychological Therapies Matrix (A guide to delivering evidence-based psychological therapies in Scotland), the Scottish Intercollegiate Guidelines Network (SIGN), and the National Institute for Health and Care Excellence (NICE). Guidance is updated regularly meaning you receive the latest strategies to help you through your difficulties.
Treatment length can vary depending on things like the type of difficulty, how severe the difficulty is, as well as other factors such as motivational issues or consistency of attendance. Your progress will usually be reviewed every six sessions. Most people notice an improvement between 6-12 sessions, however, some people may require longer-term input.
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