Your individual treatment

What is CBT?

Cognitive Behavioural Therapy (CBT) Is a type of talking therapy which is based on the idea that thoughts, feelings, what we do and how our bodies feel, are all connected. If we change one of these, then we can alter the others.

When we are low, worried, upset, or angry, we can fall into patterns of thinking and responding which can worsen how we feel. CBT can help us to notice and change unhelpful thinking styles or behaviour patterns so we can feel better.

What will happen in the sessions?

In CBT we focus on the here and now and look for practical ways to support people improve their lives on a day-to-day basis. At the beginning of each session, you and the therapist will set an agenda so that you can make sure you cover the most important things in the time you have available.

In the first session you will identify goals for the treatment which you will work towards across the sessions. It is a collaborative therapy, which means that you and the therapist will work together to support you to overcome your difficulties.

It is an active type of therapy where you will complete tasks and challenges both in the session and between sessions. These are a crucial part of the treatment and we know that being able to put time aside to undertake these in between the sessions is essential to making progress. Each time you meet your therapist, you will review how these tasks went and set new ones together.

In your final sessions, you and your therapist will work together to develop a plan that will support you to continue with the progress you have made once the sessions have finished.

How will we know if I am making progress?

There are several different ways that we measure progress in CBT. One is by checking with you at the beginning of each session how your week has been. To support this conversation, each week just before your session, you will receive a message with a link to some questionnaires to complete. These ask questions about a range of common symptoms associated with depression and anxiety and you will rate how much these have affected you over the previous two weeks. We can use your responses to track how your symptoms are changing over time. Many people we have worked with have fed back how useful it is to complete these each week to help them to think about how they are feeling and whether things are improving or not.

In addition, you and your therapist will have a review session every 4-6 sessions when you will discuss how the therapy is going and how useful it is. You will check back in with the goals you identified you wanted to work towards at the beginning of therapy and reflect on how close you are to meeting these. 

What can CBT help with?

CBT is an effective treatment for lots of different problems. It is widely recommended by national treatment guidelines across the UK, Europe and North America for a range of different problems including depression and anxiety disorders.

The National Institute for Health and Clinical Excellence (NICE) provides independent, evidence-based guidance for the NHS on the most effective, proven treatments. CBT is recommended in NICE guidelines for many different problems that we help with in the service, including:

• Post-traumatic stress disorder (PTSD)
• Depression
• Obsessive compulsive disorder (OCD)
• Panic attacks
• Phobias including social phobia
• Body dysmorphic disorder
• Generalised anxiety disorder

How is CBT delivered?

We deliver CBT in a variety of different formats to support as many people as possible to be able to access therapy in a way that is convenient for them and their lives. This includes online, via telephone or face to face, via instant messaging with our partner ieso (to find out more about this please visit Our digital partners page) and in group or individual sessions.

Richmond Wellbeing Service offers two types of Couples Therapy for service users who struggle with depression. Both models are time limited (usually 12 -20 sessions) and evidence-based treatment for depression when it impacts romantic partnerships.  

To access this treatment both members of the couple need to be living at the same address and be in a committed relationship. 

Couples Therapy for Depression 

Couple Therapy for Depression (CTfD) helps people suffering from depression by using the relationship as a resource to help support the individual and their partner. It is an ‘evidence-based’ therapy, as research has shown that this kind of couple therapy works. There are other types of talking therapies that can help individuals suffering from anxiety and depression; however, this focuses on the relationship in the context of depression. People who are depressed often find their relationships suffer and sometimes problems in the relationship can lead to one or both partners becoming depressed or anxious. Couple Therapy for Depression deals with both the depression and the relationship distress. 

Couple therapy helps those who are suffering from depression by reducing the kinds of things that make partners feel alone and distressed, or which push partners apart and make them feel angry with each other. It improves your relationship by helping you both to work together on the things that create unhappiness and to move on from stuck and sometimes hostile patterns of interaction. It helps you to understand each other at an emotional level as well as a practical one (how you feel and what you do). It gives you skills as well as understanding. This can lead to a happier and more fulfilling relationship in which differences between you are not so problematic. This relieves depression which in turn improves your relationship. This positive cycle improves mood and emotional wellbeing. 

Behavioural Couples Therapy 

Behavioural Couples Therapy (BCT) is a highly effective evidence-based treatment specifically designed for addressing depression within the context of a couple's relationship. It offers a tailored approach to couples who are experiencing low mood or depression, which can significantly impact their emotional well-being and strain their relationship. 

This therapy is ideally suited for couples who recognize that their low mood or depression is influencing their individual well-being and causing distress within the relationship itself. 

By actively participating in BCT, couples can expect to gain valuable insights, acquire effective coping strategies, and cultivate healthier patterns of communication and interaction. The therapy addresses the unique dynamics and challenges within the relationship, providing couples with the tools and support necessary to navigate through depression and restore emotional well-being both individually and as a unit. 

What is EMDR?

EMDR is an evidence-based therapy that helps people recover from problems triggered by traumatic events in their lives. It is recommended by the National Institute for Health and Clinical Excellence (NICE) as one of the treatments for Post-Traumatic Stress Disorder (PTSD) as it has been shown in research trials to be an effective treatment for this problem.

EMDR prevents difficult memories from causing distress by helping the brain to process them properly, working with memory to heal trauma from the past.

What you will do in EMDR therapy

Initially your therapist will talk with you to understand the things that are troubling you currently, including experiences from the past which may be contributing to your current difficulties. You will then spend one or more sessions preparing for processing by learning techniques to manage any distress that arises during the processing of the traumatic memories, such as developing a safe and relaxing space in your mind.

You will then spend several sessions focusing on processing the traumatic memories. In these sessions, you will think about the experience that is troubling you whilst following the therapist’s fingers from left to right with your eyes. These movements are called “bilateral stimulation” and support your brain to process and store the memory properly so that it loses its intensity and causes you less distress. At the end of each of these sessions you will spend time in the safe relaxing space in your mind so that you leave the session feeling calm.

Please do note that EMDR is not hypnosis. Even though you are moving your eyes during EMDR processing, you will always remain conscious AND in control.

What will I feel like after the session?

EMDR treatment will support your brain to start processing and storing difficult memories and this will continue in between the sessions. Some patients report that at the beginning of treatment they notice more memories coming into their mind and this can feel upsetting. The therapist will recommend that you use the techniques learnt at the beginning of the treatment to help you to soothe yourself if this happens. At the end of treatment, many people say they are no longer disturbed by their memories and feel able to return to doing things that they have been avoiding because of their difficult experiences.

Guided CBT or Guided Self Help (GSH) is a treatment that uses Cognitive Behavioural Therapy (CBT) to help people to address their difficulties with the support of one of our clinicians. CBT is a type of therapy which is based on the idea that thoughts, feelings, what we do and how our bodies feel, are all connected. If we change one of these, then we can alter the others. When we are low, worried, upset, or angry, we can fall into patterns of thinking and responding which can worsen how we feel. CBT can help us to notice and change unhelpful thinking styles or behaviour patterns so we can feel better.

GSH sessions will support you to identify the vicious cycles in your life and help you to implement changes with the aim of improving how you feel. You will learn various coping strategies and techniques to allow you to become your own therapist and prevent future setbacks. This will be tailored to your individual needs and directed towards your own personal goals.

Your practitioner will work with you to look at how your difficulties affect you in the ‘here and now’ and what may be keeping them going in weekly sessions that generally last up to 30 minutes. You will have 4-8 sessions in total.

The GSH sessions can be offered face- to-face, via video-call and/or telephone.

The sessions will be focused and structured for you to get the most out of your treatment. GSH is a collaborative treatment, so together in each session, you and a Psychological Wellbeing Practitioner will aim to:

• Set an agenda for the session
• Identify your priorities and goals for the session
• Work through a range of guided self-help booklets
• Guide you in how to use the guided self-help CBT techniques and apply them to your daily life
• Set in-between session tasks (homework) to help you practice the techniques
• Review how you get on with in-between session tasks

GSH is an effective way of helping people with mild to moderate depression and/or anxiety and is recommended by the National Institute for Health and Care Excellence (NICE). Being able to practise and apply the techniques in your daily life in between the sessions is a crucial part of the treatment and we know that being able to put time aside to undertake these in between the sessions is essential to making progress.

Richmond Wellbeing Service offers two types of individual Relational Therapy for service users who struggle with depression. Following initial consultation, you and your therapist will discuss which of the below is most likely to meet your needs. 

Dynamic Interpersonal Therapy 

Dynamic interpersonal therapy (DIT) is a 16-session model of psychodynamic therapy developed specifically to help people who are experiencing difficulties with low mood on the background of recurrent relationship difficulties. 

When you experience something painful in the past, you can develop coping strategies to protect yourself from experiencing further hurt or disappointment. These can sometimes become second nature and you can apply them to lots of different interactions with people without realising it.

In DIT you are likely to explore your current and past relationships, including early attachment relationships in search of a troublesome pattern of relating which persists and contributes to your low mood. Your therapist will help you understand the links between past and current experiences and help you focus on new ways of relating which may help you feel better. This work may include reflecting on your relationship with the therapist, as a way of getting better understanding of your relational patterns. 

This therapy is likely to help you explore your own mind and your approach to the minds of others with the help of a supportive therapist. 

Psychodynamic Counselling 

This model of relational therapy also draws on psychodynamic ideas of how the mind works. You will be offered up to 12 sessions in this model. 

One of the main ideas in psychodynamic therapy is that when something is very painful, we can try to ignore it. It’s a bit like the saying ‘out of sight, out of mind’. Most of the time we know when we’re doing this, but sometimes we bury something so successfully that we lose sight of it completely. This is why difficult experiences in the past can continue to affect the way we feel and behave in the present.  

Psychodynamic Counselling provides a safe place to talk openly about how you feel and to understand what might be causing your difficulties. Unlike in DIT you may focus more on how particular events in your life and associated painful feelings affect your mood, instead of exclusive focus on relationship patterns.  

Therapy sessions 

Therapy sessions last 50 minutes and are offered on weekly, regular basis. 

You may find that your therapist is more ‘silent’ than you are used to. At the start of each session your therapist greets you, but beyond this may not ask many questions. Instead, they wait to hear from you about what is on your mind. This isn’t because they’re unfriendly, but because they want you to have space to work out what is on your mind. This can take a while to get used to, but your therapist knows how hard it can be and helps if you find this difficult.  

Challenges in Relational Therapy 

Talking and thinking about emotional problems can be difficult. For this reason, some people can feel worse before they feel better in therapy. Your therapist will work with you to manage strong emotions as they come up. 

SilverCloud is a form of computerised Cognitive Behavioural Therapy (cCBT) designed to help manage and improve the symptoms of common mental health difficulties, such as depression and anxiety. This therapy option can be accessed through your smartphone, tablet, or computer, and provides a user-friendly and self-directed experience of CBT.

CBT is a type of therapy which is based on the idea that thoughts, feelings, what we do and how our bodies feel, are all connected. If we change one of these, then we can alter the others. When we are low, worried, upset, or angry, we can fall into patterns of thinking and responding which can worsen how we feel. CBT can help us to notice and change unhelpful thinking styles or behaviour patterns so we can feel better.

Whilst accessing this treatment, you will be assigned to and supported by one of our Psychological Wellbeing Practitioners who will set you up on a treatment programme tailored to your needs. The clinician will provide brief weekly online reviews of your progress over a course of 6 weeks, with the first and last consultation over the telephone. They will be able to view your entries on the programme and will be able to guide you with helpful recommendations along the way.

The therapy programmes available offer a range of informative and interactive ‘space from’ modules comprised of many therapy tools to help you on your journey towards recovery, these include: journaling methods, mood diaries, thought and activity diaries, relapse prevention toolkits, plus a range of evidence-based CBT specific techniques. Each programme includes a useful ‘Welcome to SilverCloud’ module to help you make the most of digital therapy.

The supported treatment will last for 6 weeks however access to SilverCloud will be for up to a year afterwards, therefore allowing people to continue working on building and maintaining the CBT skills they have learned and continuing to gain ‘space from’ the symptoms of common mental health difficulties.

SilverCloud allows for a flexible and personalised experience of self-help therapy. It not only provides a platform to help make sense of what influences mental health, but also gives you the power to choose when and where you access strategies that will move you towards healthy mental wellbeing. This approach fits in well with people who have busy lives or who find it difficult to attend regular face-to-face or telephone therapy sessions. It means that you can work on your difficulties in your own time and at your own pace.

Being able to practise and apply the techniques in your daily life is a crucial part of the treatment and we know that being able to put time aside to undertake these in between the sessions is essential to making progress.