Mental health: Conditions, support and advice

Transcript

Who are you?

Hello, I'm Dr.

Tracy Tyler and I'm a consultant clinical psychologist,

and I work for Bupa.

I'm part of the mental health support team.

I've been qualified now as a consultant,

clinical psychologist for 25 years.

Outside of work, I have a lot of things that I also enjoy.

I like going out with my dog, so we do lots of walks.

I get outdoors. I quite like being outside.

I also have friends that I do different things with.

I like going to music events.

I like just going out and generally just having fun,

chatting, catching up with them.

What is your background?

So I've been qualified for about 25 years now.

I started off working in cams with children and family,

and I then got into working

in the family courts as an expert witness.

So I've done a lot of time within the family courts,

and as part of that work, I worked with children

and families, but also with adults, with people

with really quite complex presentations including

substance misuse and other difficulties,

personality disorders.

I've also worked in severe

and profound learning disabilities, as well

as mild learning disabilities.

I spent time working in the residential care sector with

children and adolescents who had really complex needs

and were either in foster care or residential care.

I've also done a lot of work with neurodiverse conditions,

such as A-S-D-A-D-H-D,

and I also work

with foetal alcohol spectrum disorder as well.

Part of what I do as well at the moment is I work

at the occupational hub for the police.

What kind of qualifications should I look for when finding a mental health specialist?

So there are different qualifications

for mental health specialists.

Sometimes you'll have mental health specialists

who may have a degree and some postgraduate training.

Psychologists will always have a degree.

They'll have gained some experience

and they'll have a postgraduate doctorate training.

Psychiatrists would have medical training,

and then they'll have specialised in psychiatry.

But one of the important things about finding some sort

of mental health support

or some help is that they're registered with a body.

For example, the psychiatrist will be registered

with the general medical counsel.

That's their professional body.

What is the difference between counselling and therapy?

So in answering this question, I think it's important

to acknowledge that there aren't any hard

and fast rules about what the difference is.

But in general, therapy can be more structured,

so it can follow more of a format, more

of a sessional agenda.

In these situations,

therapists can be more directive in their approach.

Some therapies may require homework sessions

and things to be done outside of therapy.

And in the more structured approaches it can be

that you would focus in more on certain problems.

Counselling, however, is more led by you

and what you want to explore about yourself

or about your experiences.

So counselling can be used

to look at a number of different things.

So it could be look at relational difficulties

or things that you're finding difficult in your life,

and the counsellor in this situation would help you explore

and would look at things like being empathic towards you

and facilitate that for you.

Can a mental health condition be diagnosed during therapy and counselling?

Diagnosis of mental health conditions is always done

by either a medic who's a psychiatrist or for children.

Sometimes a paediatrician will also diagnose.

Also, psychology can diagnose as well.

Psychology tend to diagnose some of the milder

or less complex mental health conditions, whereas

psychiatry will diagnose every mental health condition,

and that's both in adults and children.

Counsellors and therapists don't make diagnosis,

so that is a difference.

Counsellors and therapists,

however, can work with the symptoms

and the difficulties that come with a diagnosis

as can psychology, and also at psychiatry.

How long does counselling and therapy last?

The length of therapy depends on a number of factors

for adults and children.

So it might be that it's dependent on what sort

of approach you want to take

and what it is that you actually want

to achieve from the therapy.

It'll also depend on how often you are being seen.

So therapy is usually on a weekly basis

for usually 50 minutes to an hour,

and that's called a session.

But sometimes people would want to spread it out fortnightly

or monthly, and this means that the length

of therapy may take longer,

and that's the same for counselling and therapy.

If you are working with really complex difficulties

that are really entrenched

and serious mental health difficulties

or personality disorders, that can go into long-term,

and that would be over months.

Is therapy helpful for individuals with ADHD?

It definitely is helpful.

A DHD is attention deficit hyperactivity disorder,

so this is when there's significant

difficulties in being able to pay attention

in being hyperactive

and also in showing really impulsive behaviours.

And this is both in adults and in children.

Quite often it's reported that the best approach to trying

to manage this is through a combination

of medication and also therapy.

The medication tends to help

to manage the more neuro biological processes underlying A

DHD, and the therapy tends to help in order to

make adjustments and develop skills for everyday living.

Not everyone with A DHD needs to attend therapy.

I only work with people who are really finding it

challenging in their environment,

possibly in their workplace,

or there might be difficulties in school.

Is therapy helpful for individuals with Autism/ASD?

So autism and a SD are the same.

A SD is autistic spectrum disorder

and therapy can be really helpful

for both children and adults.

So A SD comes with significant difficulties in social

and emotional communication.

So teaching skills in order to develop these areas

and understanding how other people think

and communicate can be really, really helpful.

It's also important to educate ourselves

and everyone around communication for individuals with a SD

as they can really be misunderstood.

Other difficulties that come

with a SD can be sensory processing difficulties

and difficulties in emotional regulation.

Anxiety and OCD can also come with a SD,

so therapy can help to address all

of these things in both adults and children.

What reasonable adjustments can be made for individuals with mental health challenges?

So the environment around individuals

with mental health challenges can create a mismatch between

what they need and actually how they can function.

So for example, in the workplace, an adult with A DHD

or a SD may need something called a reasonable adjustment,

and that is when they go to the workplace

and they explain the difficulties they have as a result

of a SD or A DHD.

And the workplace can help to put in support for them

in order to help them to be able

to function better in that setting.

In the same way, children in the school environment can have

a lot of difficulties as a result of mental health

or neurodiverse conditions.

And so going to the school

and helping them to understand what their difficulties are

and how the school can put in place support

for them can be really important in terms of them being able

to excel

and reach their potential really within the school setting.

What is Cognitive Behavioural Therapy (CBT)?

So cognitive behavioural therapy is a structured approach

that looks at the links between thoughts, emotions,

physical sensations, and behaviours.

It's an approach that will tend to take one symptom,

for example, anxiety or depression,

and it will then look at this in a lot of depth.

So cognitive behaviour therapy

will break down thoughts into small components.

For example, it would look at something called

negative automatic thoughts,

and these are thoughts that can jump into our mind

as soon as something happens.

So CBT helps you to identify thoughts that are not helpful

and it helps you to challenge those thoughts in order

to develop different types of thoughts.

CBT also assumes that our thoughts are not facts.

So thoughts are an event that happens

and it's a subjective experience to us,

which is why CBT works to then change the thoughts

because they're not treated as facts.

It will also look deeper

as well at something called our core beliefs,

which underlie all of our thoughts

and it will really get to the bottom of some

of the real difficulties that we have around

experiencing difficulties linked to thoughts and behaviours.

Is Cognitive Behavioural Therapy (CBT) the same as counselling?

So CBT and counselling can be seen as quite different.

I'd say CBT is structured

and the therapist is more directive in

their approach to therapy.

There are sessional plans more,

and there's also behavioural experiments

or behavioural exercises that run alongside therapy.

Quite often these exercises would be done outside

of the therapy session, so it takes a commitment to do CBT

because you'll need to be able to give the time outside

of the session as well as attend the sessions.

The sessions would run on average from about 15

to 20 sessions.

Sometimes it could be less

or a bit more if it's more complex.

Counselling is much more of

what we would call a non-directive approach,

and it's much more led by you

and the things that you may want to explore.

So you could look at different things in the

same counselling process.

For example, you might want to look at relationships

or things that are happening in your everyday life

and seek help for that.

The counsellor in this situation isn't directive like the

CBT therapists.

They tend to be more facilitative

and they tend to help you explore things that have happened

to you or things that you're struggling

with in your everyday life so

that you can gain a greater insight into this.

And through doing that, you can help to change

and develop different strategies.

Does Cognitive Behavioural Therapy (CBT) work?

CBT does work.

It's an evidence-based therapy,

and it's shown to work with a large number of difficulties.

It's also a therapy that is recognised by nice,

which are guidelines that we adhere to within mental health.

So it can work for anxiety, depression, OCD.

There's a large number of mental health difficulties

and challenges that it can be applied to.

It has also been generalised as well now to other areas such

as relationship difficulties

because it can be adapted to lots of different things.

Having said all of that, it isn't necessarily,

everybody will respond in the same way to it.

A really important part of therapy

or counselling is that you actually feel a connection

and an alliance with your therapist,

but also with your therapeutic approach.

So sometimes people may find CBT might be too structured

for them and they may want to have something

that's more exploratory.

So it is evidence-based and it is successful,

but it doesn't mean that it works for everybody.

What is Cognitive Behavioural Therapy (CBT) used for?

CBT is used to treat a lot

of different mental health difficulties.

It is recommended by nice,

which is our clinical guidelines and nice.

Tell us how to think about addressing different problems

such as OCD, anxiety, depression.

There is also a step care model and CBT comes into this.

So for example, the step care model would say that low level

CBT interventions might be self-help

or computerised CBT,

whereas high CBT interventions would be on a one-to-one

for more complex difficulties, right up

to step care four level, which would be a team of people

who would help somebody

with significant complex difficulties.

How long does Cognitive Behavioural Therapy (CBT) go on for?

The length of CBT can depend on what the problem is

and how intense the difficulty is.

It can also depend on how long you want to continue

with CBT overall.

However, the guidance for CBT usually is between 10

to 20 sessions,

depending on whether you want something more low level

or something that is for more complex difficulties.

Is Cognitive Behavioural Therapy (CBT) appropriate for young people?

CBT is appropriate for children and adolescents

and it can help to treat a wide range of difficulties.

It's also recommended by nice, which are clinical guidance.

CBT for younger children would be adapted.

And it's really important

that you have a mental health therapist who is able

to work with children.

Children come at different developmental stages,

and so therapy would be adapted

to help them at different stages.

So for example, younger children, CBT may use play

or it may use different visual tools in order

to help a younger child utilise CBT model.

And the CBT model is thinking about the link

between thoughts, emotions, physical sensations,

and behaviours for adolescents.

CBT is also a really effective therapy.

So in adolescence it may look, for example, at an adolescent

who was experiencing anxiety in the school setting,

CBT would help to work with that young person.

It would help them to identify negative thoughts

that they were having about the school environment.

And it would also help them to challenge these thoughts

and what we call restructure these thoughts into a way

that was a lot more effective

and helpful for them so that they were able to adapt to

that environment.

What treatment options are there for mental health and how do I know which one to try?

I think that's quite a difficult question to answer

because there's so much out there

and it can feel really confusing for families

or adults trying to find the right approach.

I think the first thing that is helpful is to think about

what it is you want to get from therapy.

Are you wanting to look at something like anxiety

or depression, a more diagnosable mental health difficulty?

Because if you are,

cognitive behaviour therapy might be the right approach

for you, or are you wanting to try

and explore something that's quite difficult?

For example, maybe there are difficulties in school

or maybe there are difficulties in relationships.

If this is what you are wanting to explore, it might be

that counselling could be a better option for you

if you are struggling

or your child is struggling

with really complex difficulties.

It might be that you want to see a psychologist,

but it's a really difficult thing

to think about where to start.

So to start with this, it might be good to visit your GP

and see if there's anything available

that your GP can suggest locally.

Often there are charitable organisations that can help

with thinking about where to start

and where you might find therapists or interventions.

Also, thinking about how long you want to have therapy for.

It's really important to think about

also the funding of this.

If you have insurance that you may need to check

how many sessions you have

or if you're going to be paying for it yourself.

Thinking also about the practicalities of

what you can spend on it.

Does exercise really help mental health?

Exercise has been found to help mental health,

and in fact, it links to cognitive behaviour therapy.

So some of the approaches

to help people suffering from depression

is called behavioural activation,

and exercise doesn't have to be going

to the gym three times a week.

It can be simply getting more movement into your life,

making sure that you go out of the house, you go

to the shops, and that you're getting your steps in.

So exercise has been found to help people

with mental health difficulties.

It can add a purpose to the day.

It can help to structure the day as well.

In particular, if people haven't got a lot in their day,

it can get people out.

So if they did decide to do something like join a gym

or do something different,

it can get them out into a more sociable setting.

Obviously, with any exercise you would need to see your GP

or seek guidance if you had any medical conditions,

and it would only ever be introduced on a gradual basis.

What are thoughts and can we control our thoughts?

To describe thoughts.

There are different ways of explaining this.

The CBT model thinks of thoughts as events that happen

to us, and so we then put

our subjective experience on it.

So CBT doesn't define a thought as a factual reality.

It defines it as something that we interpret,

and that's why CBT would say we can reprocess our thinking

and restructure our thinking

because thoughts are subjective to us all,

and thoughts can be automatic thoughts

that happen instantly when something occurs to us that sort

of just come into our minds.

Often we're not aware of all of these thoughts,

or they can be thoughts that are more longstanding,

maybe things that we've brought up from our childhood

with us about how we see others, how we see ourselves,

and how we see the world.

Thoughts. So can differ

with the different stages of development.

So children can be really what we would call egocentric.

So they can think about themselves a lot

because they just don't have the capacity.

Their brain hasn't developed enough to enable them to think

of a bigger picture

or what might be going on for other people,

but that does develop as they grow older.

Information processing, those sort of a processes, sorry,

that's a way of thinking.

We think about thoughts more like a computer.

So we store information in certain folders.

We recall information, we have memories.

So that's another way of approaching what a thought is.

The other way is to think about unconscious thoughts.

So psychodynamic approaches will think very much about

unconscious thoughts that we're not aware of,

but this approach believes

that the unconscious thoughts are driving a lot of

what we do now and creates patterns in our lives.

The second part of this question is can

we control our thoughts?

I think it's really important to understand that

when we say can we control our thoughts?

We are never saying that we should get rid of our thoughts

because we can't get rid of our thoughts.

But what we can do is we can change and adapt our thoughts,

and that's really important to understand.

The other thing about controlling our thoughts,

it's not necessarily about always thinking happily

because nobody thinks happily.

Again, it's about trying to understand our thoughts

so we can think about the ones

that might be more challenging for us,

how we can change them,

and how we can then take control of our thoughts

because we are in control of how we respond to that thought.

Are adult thoughts different to children's thoughts?

So children's thoughts are

different depending on the stage of development.

Children who are really, really young.

So for example, if you have a 2-year-old,

they have tantrums, and that is

because their brain hasn't developed enough to be able

to override that impulse.

So to say no to a 2-year-old,

or that they can't have something creates a big

emotional response.

As they get older, their brain, the higher part

of their brain will become stronger

and will be able to override those impulses.

Their ability to manage some

of their thoughts will change as they develop.

Also, children are going to worry about different things.

So children might be worried about what happened in school

and what somebody said in school.

An adult might be worried about whether

they can pay their mortgage.

So the content of their thoughts might be really different.

But when we are working therapeutically with children, so

for example, if we used a psychodynamic approach

or a CBT approach, we would still be doing the same

as if we were working with adults in the sense

that we're trying to help them to understand what the cause

of their difficulties are

and how they can manage their difficulties

and change them into something that is working for them

and something that helps them to improve their lives.

Can young people get treatment if they are addicted to social media?

So social media can be something that's really good

for young people, and it's a way of connecting

with other young people and keeping in touch,

and it can bring a lot of positives,

but sometimes that fun can stop, and when that fun stops

and it becomes a negative for young people,

it can be really, really difficult.

I think it can become addictive for young people

because they can become totally preoccupied with

what is going on in social media,

especially if there's something negative going on.

It might be that they start

to constantly check their social media.

So for example, it might be that they're being bullied.

It might be that there's inappropriate content being shared

about themselves and they're too frightened

or too worried to tell anyone about it.

So social media is a really important thing

to consider if you are worried about your young people,

and also you can seek help for that.

If I have a young person addicted to social media where do I get support?

So I think the first thing you can do if you're worried

about your young person and social media is to try

and talk to them and understand what is going on for them.

So within the family as well,

if you can keep open communications as much as you can

around social media

and normalise the fact that you want to listen to them

around what's going on in social media would be a really

good starting point.

If you're still worried about your young person

after you've done this, then there are places

where you can get help.

So one of the places you could approach is your GP

and your GP will be able to let you know

what there is in your locality

and services that could help you.

Also, some charitable organisations, they can help

with social media addictions.

If you Google them or Google your locality

and look for charities that might come up,

you can look this way for it.

The other thing is schools sometimes have counsellors.

It might be about approaching the school

and seeing whether they've got any ideas

where your child may be able to seek help.

What's the difference between a psychiatrist, psychologist, therapist and counsellor?

A psychiatrist is a medically trained doctor

and they have then specialised in psychiatry,

so they will be able to treat mental health difficulties

with medication.

Psychiatrists also can diagnose anything

around mental health.

Psychologists have done an undergraduate degree

and they've also done a postgraduate degree.

They can work with quite complex mental health difficulties

and they can also diagnose some mental health difficulties.

Counsellors and therapists, it's quite confusing

because these can be used interchangeably.

It's better really to look at the

approach that you might want.

So for example, if you want a more structured approach

to therapy, it might be that you would see a CBT therapist,

or if you wanted something that was more non-directive,

it might be that you see a counsellor

who can give you a more humanistic approach.

So the best way to think about the difference

between therapy and counselling is probably more based on

the approaches that they may both have.

Can I talk to someone about how my child’s mental health is affecting me?

I think it's really important that you have support

around you when you are dealing with a child

or a young person with mental health difficulties

because it's really easy for you

to become burnt out and really tired.

So I think there's a few things that we can think about.

One of them is thinking about just your support network

around you and can you access this

and are you accessing this enough in order to just be able

to share some of the difficulties

that you are going through.

If you feel like you need more specialist support,

then it's really important that you go to seek this.

One of the best places to start might be with your gp,

explain to the GP how you're feeling,

and the GP should be able to help you to look at

what services are in your locality.

There are also charitable organisations

or groups you might be able to find in your local area

where you can join with other parents in your situation

and also share these difficulties between you all.

But it is really important if you're struggling,

that you are able to talk to someone about the difficulties

that you are experiencing.

As a parent of a young person how do I know they are getting the help they need?

So as a parent of a young person, I think the first thing

that's really important is

that if you are noticing changes in your young person

or you're worried about something, if you can find the way

of trying to approach them and talk to them about it.

Because sometimes changes might be about something

that's going on specifically at that time.

So for example, it might be that they're having a bit

of a difficult time in school,

and so that the outcome to that could be that you need

to approach school, talk to school,

and the issue can be resolved.

If you think that there's something more going on

and there's something around mental health

or there's something around real struggles emotionally

or behaviorally, I think it would be really useful for you

to notice the changes in your child

and then to think about where you might need to go for help.

So, for example, if your child

or young person is struggling with their emotions

and they're becoming really emotionally dysregulated,

it sounds like you might want to go to a professional

or seek support around emotional regulation

through the therapy that they have.

Other things may come out

and there could be more going on for them,

but that would be a really good place to start.

How would I know if my child needs support with their mental health?

The first thing I would suggest is

that your child really well.

So it's going to be about noticing changes in your child's

behaviour or in their emotions,

or in the way that they're communicating with you.

So that's the first thing.

That may be a warning sign for you

that there's something going on with your child.

It could be depending on the age of your child,

whether they're having difficulties, maybe in their sleep,

maybe they're becoming angry a lot quicker.

Maybe they're just hiding in their room

and they're not coming out.

It might be that their eating patterns have changed,

or you're noticing that they're not mixing

with their friends as much as they normally do.

So these changes are indicators.

The first thing then, after that,

if you've noticed the changes, would be to try

and have a conversation with your child or young person

and see whether they're able to talk to you about it

or be able to give you some sort of insight around

what is going on for them.

Sometimes children and young people can do that,

but sometimes it's really, really difficult for them

to open up to you,

even if you are the closest person to them.

If you're still worried about your child, it might be at

that point then you go to seek external support,

maybe some more mental health support.

And when you start to do that, it might be thinking about

what the biggest problem seems to be for your child.

So for example, are they getting angry a lot quicker?

Is their sleep just really, really bad?

So it would be about approaching a mental health

professional or your GP

and explaining what seems to be the problem

as your child gets help.

It might be that other things come out as part

of this process, but I think

that would be a really good place to start.

Are there mental health specialists for young persons?

Definitely.

So if your child or your young person is struggling

or having difficulties, you need to find someone

who is an expert in children and adolescents.

This is because children

and adolescents are just not many adults.

So the therapy that would be carried out or the counselling

or the approach that you choose would need to be adapted

to the developmental stage

and the age of your child or your young person.

So it's really important you choose a therapist

who has the training

and the experience of working with young people.

So ways that we might adapt therapy would be, for example,

we may use play, we may use visual aids,

we may use painting.

We may use different ways with younger children in order

to help them to manage their mental health

and also develop new strategies for adolescents.

We would adapt the way in which

we approach things with them.

We may simplify things for them.

We also may have to work with what they bring us,

and we need someone who would be experienced in all of that.

How would I recognise the kind of support my child needs?

If you are worried about your child,

I think the first thing would be to try to understand

what it is you're worried about.

So are you worried about their behaviour?

And this would usually be a change.

Are you worried about something that they're talking about?

So maybe an adolescent starts to talk more about suicide

or something that you've just never heard them talk about.

If you have an adolescent, are they coming in later?

Are they starting to not adhere

to the usual boundaries that they would do?

Or if you've got a younger child,

are they becoming more easily angry

or is their sleep disturbed?

So it depends on what your child is presenting with as to

where you might seek help or how you might seek help.

How can I help my child to open up about their mental health?

I think a good starting Chloe

for this is thinking about emotions

and mental health within your family

and what sort of messages you want to give your child.

So starting with having open communication about

how you're feeling about your emotions,

and that means being able to validate your child

so when they come back

and say that they're struggling, you listen to them

and you can understand.

So trying to have a culture within the family

that supports the sharing of emotions

and mental health is a good starting point.

If you are worried about your child

and you want to have a conversation with them to try

to see if you can help them to open up about something,

I think the first thing would be to try

and think about when to do it.

So when to do, it might not necessarily be when you are

sat over a table.

Sometimes children

and young people can respond

to opening up more when you are on a drive in the car,

maybe when you're doing something together,

but isn't always an intense setting.

So trying to find the right setting

and the right time for your child

because you'll know your child will

be a really important thing.

And then in terms of approaching the conversation with them,

it would be trying to offer them a nonjudgmental space

where you want to listen to them.

So try not to interrupt them if you can get the

conversation going with them.

It might be you start the conversation

by sharing a little bit about your day.

You could say something like, oh,

today I felt a little bit sad today because this happened.

I wonder how things have been for you.

Or you could have asked them something like,

I've noticed you've been a bit quiet recently.

Try not to ask them what we call closed questions,

which makes them say yes or no.

Try to ask them the open-ended questions

that they can give a response to you

if your child is then able to start to talk

to you about what's worrying them.

Just try to be quiet

and just try to listen and feel comfortable.

Silence. If they stop, it might be

that they're thinking about what they

might want to tell you next.

So just try to allow some silence with them.

And also it'll be about validating what they're telling you.

So if they come out with something that's really difficult

for them, it might be you say, it sounds like

that's been really, really tough for you.

If you can try not to fix it for them

or offer something that they should do or to do, try

and just sit with it

and allow your child almost to leave you

with the information that they've just given you.

Is there anything I can do to understand my child’s mental health better?

I think one of the things that you can do is to

have a relationship with your child

where you are interested in your child's life,

where you have time to spend with them,

where you can do things together.

So you build a relationship that's quite strong

with your child when you've got that,

you also know your child.

So it will be about looking at any changes

that they may have in their behaviours or emotions

or anything that you think like, oh,

I'm not so sure about this.

I'm not sure how they might be doing.

Keeping communication as open as you can,

so not being frightened to ask your child,

how do you feel today?

Or, I've noticed that something might be going on for you.

Is there anything that you need help with?

But equally, it would also be not putting pressure on your

child, which can be a really difficult balance if you're

worried about them, because sometimes they can't tell you

what might be going on if they're worried.

And sometimes that might be

because it's the wrong time for them

and they're not ready to talk about it.

Or it might be that they need to talk

to someone a little bit more distant.

But I think if you try these things with your child,

then you're doing everything you can to understand them

and keep on top of their mental health.

Would therapy be helpful if my child is struggling with friendships?

Struggling with friendships

for children can actually be something that's really,

really difficult because it can impact on a lot of areas

of their life, including the school setting for them.

So if your child is having a lot of difficulties

with their friendships, I guess there's a

couple of things you can try.

The first one would be to try

and understand is this just something that's come up now?

So for example, there might be a new child in school,

or it might be that your child's changed friendship groups.

So it might be a period of adjustment

where your child is having to develop some new skills,

but actually because it's a change with some support

and some talking to you, you can actually help them with

that and they'll move on

and everything will settle down again.

But then there might be circumstances

where your child is really struggling with friendships

and they might need some extra help with that.

For example, children who have autism struggle

with friendships and children with A DHD can not always,

but can struggle with friendships.

So if your child is struggling with friendships, it might be

that you try to seek some support,

and that can be therapeutic support.

It could be about approaching a therapist or a counsellor

and asking if your child would be suitable

or whether they were the right person,

thinking about whether they were the right person for you

to try to help your child.

There can be different things that can be done for children

who are struggling with friendships.

Some of those can be just teaching social skills,

so making your child aware of how to listen, how

to take turns, what other people might be thinking.

That can sometimes be enough to help your child.

Other times it might be

that there are different things going on for them.

They may have, for example, it might be in a school setting.

They're struggling with social anxiety more,

and that's impacting on their friendships.

So if that's something that comes out,

then they may need some help to manage their social anxiety,

which in turn will help them to manage their friendships.

And obviously sometimes other things may come out as part

of the therapy and actually the friendships is just

part of a bigger picture.

But it's important that if you are really worried about your

child and their friendships, that you are able

to go out and seek support.

And if you're really not sure where to start,

your GP would be a really good place.

Would therapy be helpful for my child if they are having conflict with parents or teachers?

Therapy can be helpful if your child is having conflict

with school and teachers or yourself

before you go to therapy.

It's just about trying to understand yourself,

a little bit about the problem if you can.

So if you've noticed that your child is suddenly having

difficulties in school or they're getting worse

or at home, it's about trying to sit down with your child

and see if you can talk to them about it

and see if you can try

and understand what is happening for them

and why this might be coming up for them.

If you're still worried about your child,

then therapy can help with that.

So school is an environment that can be really challenging

for children and young people

who have their own difficulties anyway.

So school has a lot of

what we would call demands placed on them

because they're expected to sit, they're expected

to concentrate, they're expected to learn,

and these are all massive things that are really,

really difficult if they've also got other emotional,

behavioural, or psychological difficulties.

So if you are seeking therapy, it would be

for a child or an adolescent.

It would need to be with a mental health, a practitioner

who has experience with children and adolescent.

And sometimes these practitioners would also link

with school as part of the therapeutic process as well.

It might be that you want to find a practitioner

who does this, or it might be that

you're not worried about the linking with school.

In therapy though, it can help the child

or the adolescent or yourself

to join the therapeutic process

and to try to understand what is causing,

what is underlying these difficulties at home or in school.

Work with children and young people

might also involve yourself as a parent

or a guardian getting involved in the process with them,

so you are part of that journey.

I think in the school environment, it's really important

to try and understand what is happening in that setting

for them, and do they need

to have extra support put in place for them

or something different to what is happening in

that environment in order to help them there.

What is Psychodynamic therapy?

Psychodynamic therapy is an approach to therapy

that thinks about unconscious thoughts.

So the premise of this therapy is

that we all hold unconscious thoughts

that are more difficult thoughts

and we're not aware of them.

These thoughts are often thought

to have originated in childhood experiences,

maybe in the relationship between a child and parent,

and they become stored in our unconsciousness.

But even though they're in our unconsciousness,

psychodynamic therapy believes that they are

influencing our current day-to-day thoughts and behaviours,

and also the challenges that we face.

It tends to look for patterns in our lives

that may have originated in childhood that we then go on

to repeat in other areas of our life.

In psychodynamic therapy, therapist is seen

as a really important point of therapy.

It's understood and thought that people

and children, including adults in therapy, will reenact

behaviours and situations with the therapist,

and this is called transference.

And the therapist will use this as part

of the therapy in order to try to help the young person

or child or the adult

to overcome some of their difficulties.

It's also about bringing into awareness defence mechanisms

such as denial, which is not being aware of something

or repression and bringing them out so that we can,

or the people in therapy can understand what these are,

and then once they're in consciousness, they can work

with them.

Is Psychodynamic therapy appropriate for children?

Psychodynamic therapy can be used with children.

It's often used for when

we're working with younger children.

It will be through play.

So in psychodynamic therapy, the child is able

to express unconscious thoughts, unconscious feelings,

and unconscious impulses through the play

that they show the therapist in the room.

So the therapist would analyse the play

and work with the play.

They may offer interpretations to the child about

what is going on in the room.

The therapist will also consider the relationship

that the child builds with them

and what is called the transference in the room,

and they will use that as part of the therapeutic approach.

In terms of adolescents, it might be that this is done more

through talking, it's more done in a way

that the adolescent

or the adult would bring what they wanted

to into the therapy with them.

And it is through talking about current situations

and difficulties that the therapist would then help them

to understand unconscious thoughts that they may have

and also the origin of these

and why they may be reenacting difficulties

that they had in earlier life in their current situations.

But the premise of this will be

that the unconscious thoughts are driving the current

difficulties and behaviours.

What is interpersonal therapy (IPT)?

So IPT is a form of therapy that takes the approach

that relationships are the key

to our mental health wellness.

So if our relationships are suffering

and we're really struggling in our relationships,

then it impacts on our mental health.

So in order to feel better

and improve our mental health, we need

to improve our relationships.

So IPT can be used with children and adolescents

or with adults, and it tends to look at

how we can improve things within these relationships.

And the way that it does that it

considers things like is there any grief

or any loss that is in individuals that they are left

with that is unresolved.

So helping them to process grief

and loss, looking at role conflict.

So it might be that a couple has

difficulties in their relationship because there are

difficulties of their expectations of each other.

Within that role, it's using roles within families

and within dynamics to explore that

and see whether roles can be amended

and changed so that the dynamics can work better.

It also helps to look at life transitions.

So it might be that somebody's going

through a big life transition.

So for example, even just going from primary school

to secondary school or somebody who's going

through retirement, helping to look at life transitions

and how that is impacting on relationships

and also interpersonal skills.

Just looking at the general interpersonal skills people have

and if there are any deficits that they may need support

with.

Is Interpersonal therapy appropriate for children?

Interpersonal therapy is appropriate for children

and it has been adapted for children

and also for adolescents.

So for younger children it would be

an approach using more play-based information

or more visual information so that can,

the therapists can help the child

to look at the relationships that they have

and how they may be able to improve the relationships

with other people, and also to look at the feelings

that the child has within that relationship

and what may not be working for them.

It would also involve working with the parent as well,

or the guardian of the child in order to help the parent

and the guardian to look at their relationship from their

perspective and things that they may need to change.

It's the same for adolescents.

The play wouldn't be used for adolescents,

but it would be done through talking

and it would be thinking about difficulties

that adolescents may have in their roles

within relationships.

It might be about changes that the adolescent is going

through that is causing a difficulty

or just their interpersonal skills within relationships,

and the parent or the guardian would be involved in those

sessions as well to have a look at how

that dynamic can be improved.

What is Dialectical Behaviour Therapy (DBT)?

So DBT is an approach that originally was designed

for really complex difficulty, such as personality

disorders, in particular borderline

or emotionally unstable personality disorder.

And it very much focused on helping individuals

to accept themselves, to accept the difficulties

that they have, but also through behaviour

to change these difficulties.

It has subsequently been generalised to a lot

of different populations now,

so it's not just complex difficulties who utilise DBT,

but for example, A DHD can have difficulties

with emotional dysregulation,

and DBT can be helpful in these situations.

So DBT works by thinking about helping people

to become aware of just living in the moment,

accepting things that are happening within the moment

and becoming aware of their feelings, their behaviours,

and their thoughts within the moment.

It also has an ability to help people to learn how

to tolerate high levels of distress.

So for example, people who have suicidal thoughts

or self-harming thoughts, it helps them to work on how

to accept when those thoughts are there,

accept those thoughts without acting on them.

Sometimes it offers strategies and approaches to try

and change some physiology around that,

but it very much is around distress tolerance.

It also works on emotional dysregulation

and how to understand the things that trigger you

to display certain behaviours

or to experience certain really intense, difficult emotions.

And DBT also looks at stabilising people's lives

through simple things like eating patterns,

sleeping patterns, and helping them

with their interpersonal skills so that they're better able

to communicate and build healthier relationships.

Is Dialectical Behaviour Therapy appropriate for young people?

In my experience, it is really appropriate for adolescents

who are going through significant periods of change.

In particular, if adolescents are having significant

difficulties in their emotional regulation

and may be experiencing impulses to harm themselves

or more difficult emotions.

So DBT can help adolescents in these situations

by first of all, helping them to accept their situation

and also to understand their situation more.

It's very much based on looking at the behaviours

that they may be showing

and understanding how to manage these.

It uses thoughts. It uses emotions.

If an adolescent is having a lot

of difficulties in their emotional regulation,

it might be about teaching them how to

live in the present moment more, how to be more in tune with

what is going on around them.

Also making them much more aware about the difficulties

that they're experiencing

and how this is resulting in high levels

of distress in themselves.

It also helps to educate

and helps to teach skills around distress tolerance.

So the adolescent learns how to live with the emotion

and just sit with the emotion in the moment,

but not necessarily act on it.

And this is done through giving them strategies

at that point in time.

There's a phrase called radical acceptance,

and this is about just accepting how they are in

that moment, but resisting the impulse to act on it.

In addition to that, it will help the adolescent to build

just everyday life skills, so put in place sleep patterns,

putting place regular eating patterns,

think about their social skills, how they engage

with their friends and family.

It helps to open up communication

and also it helps the adolescent to learn how to be

more assertive about letting other people know

what their needs might be and how to voice this as well.

What is Eye Movement Desensitization and Reprocessing (EMDR) therapy?

So EMDR is a specific approach used mainly

to trauma memories.

EMDR works on the premise that

trauma memories get locked in your mind

and they become associated

with the actual event at the time of the trauma.

So when you think about that event, you relive

that event in the emotions and the feelings

and what you see as if you were actually back in

that place in time.

So EMDR works to

what we call reprocess these trauma memories

and to desensitise the person to these, it uses

a technique where it provides a stimulation

to the person at the same time

as then thinking about the trauma memory.

So this can be used with children,

it can be used with adults.

So at the time of thinking about the trauma memory,

the therapist will do something that is bilateral.

So they might tap, for example, tap your leg,

or they may ask you

to move your eyes from the left to the right.

So you are acquiring your brain

to do two things at the same time.

And EMDR has been found to be really effective at being able

to reprocess these trauma memories

and make them so

that the individual can think about the event,

but without all the distress that is associated with it.

Is Eye Movement Desensitization and Reprocessing (EMDR) therapy appropriate for children?

Yes, EMDR can be used with children when it comes

to trying to process trauma memories, which is

what EMDR can do really effectively with children.

The therapist will ask the child

to think about the traumatic event,

and at the same time, they will give the brain a stimulus.

So for children it might be that they use drumming

as the stimulus alongside the child,

thinking about the traumatic event.

And it is through using both of these things that EMDR works

by reprocessing the trauma that the child has experienced.

And through doing this, it desensitises the child

to the memory so that the child is able just to think back

to the event that happened without all the distress

that is associated with it.

And EMDR therapy can also bring in other areas of work.

So for example, it can also use play

or other techniques with children in order to help them

to reprocess their trauma.

Does individual therapy work with children?

Individual therapy can be highly effective in working

with children, but it is quite usual for therapists

to ask the person bringing the child to therapy,

which is usually the parent

or the guardian to sometimes join in

the therapeutic process.

How often that happens will depend really on the therapist

and on the type of therapy that is being offered.

So for example, if you are attending a therapist who's a CBT

therapist and you've got a young child, it is likely

that you'll be involved in some of the sessions so

that you can learn how to support the therapy outside

of the session in the home environment with your child.

So you sort of become like a co-therapist

as well in helping your child.

In other situations it might be that the therapist will work

with you to look at how you can build coping strategies

and ways of helping your child

to manage their emotional dysregulation

or whatever the difficulties are so you become part of

that therapeutic process.

There are also specific approaches to therapy,

which is about the dynamic.

So DDP is an approach to therapy,

which is diadic, developmental psychotherapy,

and this is very much based on working with the child

and the parent or guardian in the therapeutic process.

And it looks at the dynamic between both of them

and how to improve that.

There's also family therapy

and this is where members

of the family can be involved in the whole process.

And this would be an approach

that could be used when there are a lot of

difficulties within the family and within the dynamics.

It may be sometimes that

a family member may have their own one-to-one therapy

running alongside the family therapy as well.

As a parent would I sit in with my child during their therapy session?

It's quite common for parents

to be involved in the therapy sessions,

but how much involvement they have will depend on the age

of the child, the presenting problem,

and also on the therapists

and the type of therapy that you are attending.

It's really common for younger children to have,

well, for the therapist who's working with younger children,

to also work with the parent to help them to understand ways

to manage the child, and also

to understand why the child might be presenting in a certain

way so that they can support the therapeutic process in

the home environment.

There are specific approaches to therapy, such as diadic,

developmental psychotherapy, where the therapy is designed

to have the parent or the caregiver in the sessions

with the child, and the therapy will focus on the dynamic

between both of them in order to help move things forward.

If my child needs urgent help, what should I do?

If your child needs urgent help, I think you need

to assess how urgent it is.

If they're at immediate risk of harm

or in imminent danger, you need to dial 9, 9, 9.

If you think your child needs urgent help,

but they're not at risk of immediate harm

or imminent danger, then one.

One. If you are worried about your child

and you think that they need help,

then you could visit your GP

and they can help you to think about the services

that you may need to access.

There are also charitable organisations

where you can self-refer,

and it might be that one of these organisations can also

help you with what you're worried about.

I feel overwhelmed because of my child's mental health, how do I take care of myself?

I think this is a really important question

because I think any parent who is trying

to support their child with mental health difficulties

will have a really challenging time,

and I think it's challenging on a lot of different levels.

So it may be that you are not getting sleep at night

because of the difficulties your child is having,

so you are becoming really, really tired.

I think it's really, really normal to feel

that you are not getting it right

or maybe to question yourself.

I think it can be really normal to blame yourself,

even though it's not your fault.

You may start to blame yourself for things

that aren't your fault.

It can also be really normal for you

to feel like you might be failing.

You're not failing, but it's how you feel.

So it's really, really important that you try

to look after yourself.

Ways that you can try to look

after yourself are getting a break,

and that might be really, really difficult

for you if you haven't got anyone

who can look after your child.

But if you can try to get a break, how often that is

for you will depend on how often you can have one.

So that's the first thing that you can do is

just give yourself a break.

Have you got an outlet where you can join a group of friends

or you can do something with them

that might be on a monthly basis?

It depends. Or a fortnightly basis depending on

what you've got going on in your life.

But what can you have in your life that is going

to allow you to release your stress

and also the pressures that you've got with your child.

So it's also about seeking the support systems

that you've got around yourself and talking.

So being able to talk to people about how you're feeling.

If you've had a really bad day,

have you got someone in your support system?

You can pick up the phone to

or your partner that you can sit down

and talk to at the end of that day

and who can help you basically in terms

of managing your stress

and also help you to process what's been going

on in that day.

Sometimes it can be really difficult

to get a good night's sleep if you are child is up in the

night and you are not able to.

But if possible, trying to think about your sleep routines

and whether there's anything you can do to make sure

that you are getting enough sleep, if that's possible.

And also just healthy eating, making sure you're looking

after yourself, you're eating healthily

and you are eating foods that are going to be good for you

and give you energy

and the energy that you'll need in terms of trying to care

for your child.

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Transcript

Who are you?

What is your background?

What kind of qualifications should I look for when finding a mental health specialist?

What is the difference between counselling and therapy?

Can a mental health condition be diagnosed during therapy and counselling?

How long does counselling and therapy last?

Is therapy helpful for individuals with ADHD?

Is therapy helpful for individuals with Autism/ASD?

What reasonable adjustments can be made for individuals with mental health challenges?

What is Cognitive Behavioural Therapy (CBT)?

Is Cognitive Behavioural Therapy (CBT) the same as counselling?

Does Cognitive Behavioural Therapy (CBT) work?

What is Cognitive Behavioural Therapy (CBT) used for?

How long does Cognitive Behavioural Therapy (CBT) go on for?

Is Cognitive Behavioural Therapy (CBT) appropriate for young people?

What treatment options are there for mental health and how do I know which one to try?

Does exercise really help mental health?

What are thoughts and can we control our thoughts?

Are adult thoughts different to children's thoughts?

Can young people get treatment if they are addicted to social media?

If I have a young person addicted to social media where do I get support?

What's the difference between a psychiatrist, psychologist, therapist and counsellor?

Can I talk to someone about how my child’s mental health is affecting me?

As a parent of a young person how do I know they are getting the help they need?

How would I know if my child needs support with their mental health?

Are there mental health specialists for young persons?

How would I recognise the kind of support my child needs?

How can I help my child to open up about their mental health?

Is there anything I can do to understand my child’s mental health better?

Would therapy be helpful if my child is struggling with friendships?

Would therapy be helpful for my child if they are having conflict with parents or teachers?

What is Psychodynamic therapy?

Is Psychodynamic therapy appropriate for children?

What is interpersonal therapy (IPT)?

Is Interpersonal therapy appropriate for children?

What is Dialectical Behaviour Therapy (DBT)?

Is Dialectical Behaviour Therapy appropriate for young people?

What is Eye Movement Desensitization and Reprocessing (EMDR) therapy?

Is Eye Movement Desensitization and Reprocessing (EMDR) therapy appropriate for children?

Does individual therapy work with children?

As a parent would I sit in with my child during their therapy session?

If my child needs urgent help, what should I do?

I feel overwhelmed because of my child's mental health, how do I take care of myself?

Guides, articles and support

Anxiety and depression: what’s the difference?

Panic attacks: what are the symptoms and treatments?

Getting support for different types of addiction

Understanding depression

What is anxiety?

Grounding technique with Bupa CBT therapist

Mental health stories

Colin’s story

Anne’s story

Sam's story

Mental health support for the whole family

Mental health support for families

Men’s mental health

Young people’s mental health

Young people’s mental health support

Children with dental phobia

What is childhood anxiety?

Depression in young people

What is an eating disorder?

How to look after your mental health

Sleep and your mental health

What to do when you feel burnt out

How to stay in control of stress

Sleep and your
mental health

What to do when
you feel burnt out

How to stay in
control of stress

10 things to help a
friend with anxiety

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