unempathic NHS mental health counsellor services

[missabc123]

Hi all, I have some long term mental health issues (10+ years) that are severely impacting on my life (all areas of). The issues are of a very personal nature and very difficult for me to talk about - and I have never been able to discuss with anyone to date, just locked them away inside driving myself nuts to the point of crisis.

I have tried NHS counselling a year or so ago and had 6 sessions of CBT / talking therapy with an intermediary mental health worker (you can get this in place of the longer term proper counselling as the waiting lists for that are so long!) which kind of helped but I didn't feel able to discuss root cause of what is bothering me. Probably because I had a young baby and was just going through a terrible time with his dad made it too difficult to get to the longer term issues on top. In addition to this although the lady was quite nice I never felt she was particularly empathic so could not open up fully.

Now my baby is two and the life situation slightly easier I am ready to discuss my real issues and have just gone for my mental health assessment. I have opened up to the mental health worker about the reasons but she seems professional but emotionally cold. This seems to be my issue to date with both the counsellors I have seen. As the issues are so personal and deep seated opening up to anyone is very hard. What I really want is some level of empathy and understanding yet when discussing the issues is done in a clinical manner it leaves me feeling worse about things and like I am a bother to them.

I do understand they have to maintain professional boundaries but I find the lack of warmth difficult to deal with. Particularly as I have been unable to discuss this to date. I feel that their professional distance somehow trivialises my issues and makes me less inclined to discuss.

I know that there can be issues with getting "close" to clients as a counsellor but I really do feel I need some level of empathy and recognition about what I have been through other than a clinical distanced approach from a therapist. What is the best way to achieve this? Is there any way to get this through an NHS Service?

I think it's just I have been "out in the cold" so long I need a warm approach to open up. This doesn't mean I want to be best mates with the counsellor but more that I just want recognition, and feedback on it, so I can process it. I'm also keen to properly move on, I am not wanting to have therapy forever, I just need to process this stuff that has been locked up so long driving me nuts, and get it done with in the right way.

I'm also aware that maybe them going too far into issues on an empathic level can somehow stick you further into them, by focussing on the issues more, but I think for my situation a little empathy would help.

At present the mental health worker is discussing my needs with the next level of therapists and there are three different options I may be given - 1) further sessions with her (up to 6) or 2) counselling - longer term -or 3) CBT - longer term. The longer term options may take several months to get availability but I am desperate for help now.

Does anyone have any feedback about the NHS mental health services process, if an empathic based service would help, if it is possible to get such a thing through the NHS or maybe I need to go private (not ideal for cash flow reasons but could consider if necessary). I would also welcome thoughts about why the NHS service maintain such a professional distance, if they can cater to individual needs a bit better (probably wishful thinking given their budgets!), and if anyone else has had a similar experience...

Many thanks :-)

Some great advice on here from various posters, so wont repeat too much..

However do want to point out that you are right and very insightful to realise what you feel you need is empathy and connection with therapist. Wish I had realised this earlier in my therapy journey would have saved a lot of wasted time!

The other thing I wanted to repeat is that talking therapy - despite what the politicians say - is very difficult to get on the NHS unless you have severe conditions and/or are lucky with your health trust being one of the well funded ones.

I've had dreadful experiences trying to get NHS help and after a long battle have gone private now. Wish I had sooner. From what I have ascertained now, a lot of NHS treatment is lower experienced counsellors doing CBT and it sounds like you need/want to do something more in depth.

If you can afford to go private you are lucky so I would recommend trying this route, any experienced therapist will understand if you want to try out a session to see if you feel comfortable and want to proceed.

Good luck op

When going private choose someone who is a member of one of the main accrediting bodies which are BACP, UKCP and BPC. Most therapists will offer one or two initial assessment sessions which are a chance for both of you to explore what has brought you to therapy and if you can work together. Many people seem to think the assessment should be free of charge but I disagree - why would a therapist be expected to work for free?

When I chose my therapist she was the only one I saw but it's ok to try someone else if you really don't get along with the first one.

thanks guys really appreciate the advice!

I am still concerned re. the CBT not being what I need although I feel it will help with some of the issues. I definitely need to talk things through as well.

I'm amazed that the NHS seems to be so reluctant to give out talking therapy when I imagine it could be the most helpful for a lot of people.

Stripy - I might call up some therapists and have a chat on the phone; will definitely check out BACP, UKCP etc, as suggested, so thanks :). I wouldn't expect a free session and don't think I would want to go through it all with loads of them so maybe a quick chat would suffice in the first instance.

Mumwithcamera - you've got some great advice there in your post and I am noting it all!

This thread has been a real help with me for helping me get a handle on what I want and need. I am surprised that the NHS didn't seem to think that talking therapy would help (or weren't prepared to give it to me); I appreciate CBT can be a good distraction technique and change your behaviour but i think if you've kept things bottled up for years it's healthy (and probably vitally important) to talk about it through therapy / counselling at least in the short to medium term. Sounds like private is the only option for this (at least at this time if I want it sooner rather than later).

Many thanks everyone. :)

hello all, it's been a while since I updated on this, but one or two mentioned they would be interested for me to post back on my progress with my NHS therapy.

I was assigned CBT, which I doubted would be helpful, however it has proved brilliant and really helped me through some of the more challenging issues I have been facing.

I cannot condone it enough. I'm not entirely sure if it's the CBT therapy, or the lady who was doing it (who has been great), or the just talking to someone about something I have been unable to do for a long time, but I have made huge leaps forward and am very grateful for this.

I had 12 sessions in the end, at the beginning I was skeptical but I am glad I stuck with it. I still think I have some work to do and may follow up with some other kind of therapy in time. But for now I am very grateful for the therapy I have received.

I would have thought all forms of therapy should be founded on building a strong therapeutic relationship. It's about creating a sense of trust, and the therapist should be empathetic.

Part of the reason the therapist doesn't reveal a lot about themselves is so you don't form a judgement / bias about them as a person, their likes and dislikes etc. which could alter what you feel comfortable discussing with them. It helps with providing an objective, safe space.

I'm happy with this approach. And, as I pay for my therapy, I don't want to waste my time and money discussing my therapists personal life etc.

I read this article on current NHS IAPT service and CBT therapy, by a former NHS therapist which is quite interesting - obviously just one view though.

www.therapytoday.net/article/show/4797/when-cbt-doesnt-help/

That's great to hear that it was such a help to you. Was it quite "pure" CBT? Experiments and thought records to do between sessions?

thanks notajammy, I will take a look at the article soon! Looks interesting. I think in this case I really clicked with my therapist and it wasn't only the therapy itself that helped but the lady working with me and also I felt a sense of accountability due to going through the therapy, it kicked me up the bum as it were, so I had to fulfil on my tasks assigned through the therapy.

Changeasgoodas - I'm not really sure if it was "pure" CBT as I don't have experience of it but it was called "CBT" when I enrolled so I presume so. We did do some worksheets in sessions and I had some "homework" in a loose sense for goals to achieve and and also worksheets to ensure I didn't slip into negative thinking patterns again, to remind myself what they are etc. I think a large part was the therapist, as I said above. It's just been great to be able to trust someone to talk to them about problems that have been locked up inside for a long time. My therapist has been great and I have come on leaps and bounds since starting although it has been a tough journey in many ways! But worth it. :-)

Certainly sounds like a predominately CBT course. As you say, relationship with the therapist is paramount though. I was wondering, if you don't mind answering, did you find her more empathic than the previous people you met? Do you think the conversation on here changed your perception of how she was reacting to you?

yes definitely more empathic, we really clicked. I probably do think this thread helped a bit when considering the ins and outs of therapy and the boundaries necessary, however I think it was her and me clicking more than anything. But it's been very useful to know why that professional distance is necssary. It's not explained to patients (? clients?) beforehand, it might help some patients to understand a bit more about the process of therapy before engaging in it so they don't have preconceptions or misunderstandings about the process. That said I can't condone the empathy side of things enough. It really helped me.

The first lady I recently saw only for one session (gateway therapist) who redirected me to this sequence of therapy I found very cold, that said it was only one session, and in retrospect it does take a little time to build up a relationship, I understand this now given my experiences with my CBT therapist. That said I did feel the first therapist could have been much more encouraging or warm, it felt so clinical and for someone on the first steps of a healing journey who is already anxious and finding opening up hard, a little warmth really would go a long way in my opinion. It might have put me off going further if I had not been at the point of real desperation for help.

In my original therapy a couple of years ago it was a case of getting to know the therapist too, I only had six sessions but by the end of it I felt we clicked better than at the beginning. That said I never felt I could get to the place to open up properly to her on the important stuff, I think this was probably due to my own situation at the time (bad PND, so much other stuff going on in my life that it was difficult) and probably we didn't click as well.

Thanks Miss. Glad you stuck with it despite the shaky start and hope the recovery continues for you. I think your honesty on this thread makes it really helpful for others too.

Thanks for updating
Really pleased that it helped you

I think it's hard because they aren't supposed to neccesarily validate your feelings, which can sometimes lead to feeling of lack of empathy. Phrases which seem so innocent ike
'its okay, you're fine'
'its okay'
'i completely understand'
'its normal, don't worry'
can be problematic in some contexts. A lot of therapy needs a neutral person, you need that person to help you explore your feelings rather than them giving you their own emotions on the matter, this can subconsciously influence you. These people aren't there to coddle, they're there to get you to work to figure out what's going on and prompt this. I get though for some people this may seem cold, and for some people a warmer environment may be better but I imagine it's difficult to tailor to each person without influencing, validating or whatever.

I had the same problem with CBT. I think I misunderstood what their role is really. That's why theres a difference between roles like support workers and therapy.