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The best treatment for mental illness can include a combination of medication, psychological treatment and support in the community. Many people affected by anxiety disorders and depression, especially, are helped by psychological, ‘talking’ treatments, and this pamphlet answers commonly asked questions about them.

 
How do psychological treatments help?
Psychological treatments help by giving an opportunity to talk about thoughts and feelings with a specially-trained professional in order to understand your symptoms, and to help you cope better with them.

 
What do we know about psychological treatments?
You play a role in the therapy yourself

Psychological treatments help you to understand what might be contributing to feeling the way you do and support you to try strategies for feeling better. This can be challenging but it means you play an important part in your own therapy, and this in itself is empowering.

 
Real change takes time to happen
Psychological treatments do not work instantly, but over a period of months will help you to learn new ways of thinking, behaving and even feeling. You may notice, for example, that you are better prepared to handle things that used to worry you or get you down. Eventually you may {nd the whole way you think of yourself and the way you perceive and respond to the world changes for the better.

 
Sometimes they work best combined with other treatments
Psychological treatments are often effective on their own for people with depression and anxiety disorders. Sometimes it is also useful to combine them with other treatments such as medication. For some people, with psychotic illnesses such as schizophrenia and bipolar disorder, for example, ongoing rehabilitation, accommodation and employment support are also needed.

 
What psychological treatments are there?
There are many types of psychological treatment which are proven to be effective. These may be provided individually, as part of a group, as a couple or even as a whole family – depending on the nature of the problem. Some common psychological treatments are:

 
Cognitive behaviour therapy (CBT)
In CBT people discover how their thoughts, feelings and behaviour can get stuck in unhelpful patterns, and are supported in trying new, more positive ways of thinking and acting. The person and therapist form a shared view about the unhelpful patterns and agree on goals. Therapy usually includes tasks and challenges to do outside, as well as within, the sessions. In addition to treating depression and anxiety disorders, CBT may be helpful to people with psychotic disorders such as bipolar disorder or schizophrenia.

 
Interpersonal psychotherapy (IPT)
IPT is based on the idea that the way people relate to each other affects how they think, feel and act as individuals. It involves looking at the way a person has related to signi{cant people in their life and finding more positive ways of interacting with others. Difficult relationships are stressful and may contribute to worsening of symptoms for some people with mental illness. Addressing these difficulties therefore may help improve their quality of life. IPT has been found effective in treating a range of mental illnesses, especially depression; it is much less commonly used for people with psychotic illnesses.

 
Dialectical behaviour therapy (DBT)
DBT is a form of treatment specifically for people with borderline personality disorder (BPD). DBT is based on the idea that a key problem for people with BPD is an extreme difficulty in handling emotions. DBT helps people learn to handle their emotions better and re-learn the way they typically respond to situations and other people. DBT generally combines individual and group therapy.

 
Family interventions
These treatments aim to support families and other carers, and foster calm and constructive family relationships where a member of the family has a psychotic illness such as bipolar disorder or schizophrenia. Highly emotional environments are stressful for people with a mental illness and can lead to relapse. Family intervention sessions typically focus on education about mental illness, solving of problems encountered as a result of the illness, and improving communication and relationships where these are strained or stressful. The meetings may include some or all members of one family or, alternatively, the members of a few families may meet together in a ‘multiple family group’. Psychoeducational family interventions can reduce relapse rates for people with schizophrenia and depression whilst also supporting everyone in the family.

The more severe the effects of a mental illness, the more difficult it can be for the person to engage in a psychological treatment, although the therapy may still be helpful. In these cases, it is likely that medication and practical support will be required in addition to any psychological therapy.

 
How long do they take to work?
Psychological treatments vary in the length of time they take to work.

Approximate numbers of sessions

- CBT (weekly one hour session)   10-15 sessions

- IPT (weekly one hour session)   20 sessions

- DBT (weekly one hour session and weekly group therapy session)   2-3 months

- Family Interventions (monthly sessions)   9-12 months

The benefits of psychological treatments happen at a different rate for individuals, and these are approximate numbers only.

 
Who provides psychological treatments?

General practitioners (GPs)
An appointment with your GP is always the best place to start if concerned about your physical or mental health. As well as making an assessment and diagnosis, a GP can prescribe a Mental Health Care Plan, which may include referral to a psychiatrist, psychologist or other mental health professional for treatment.

Psychiatrists
Psychiatrists are medically qualified doctors who specialise in the study and treatment of mental illness. They can therefore prescribe medication as well as provide psychological treatments. The cost of seeing a psychiatrist is is largely covered by Medicare. Those accessed through Community Mental Health Services and public hospitals do not charge fees.

Psychologists
A psychologist is a health professional trained to provide treatments to people with emotional and mental health problems. When referred by a GP as part of a Mental Health Care Plan, seeing a psychologist for a course of treatment is largely covered by Medicare. Psychologists accessed through Community Mental Health Services and some Community Health Services do not charge fees.

Other mental health professionals
Other mental health professionals in Community Mental Health Services may also be able to provide psychological treatments. These may be social workers, nurses, psychologists or occupational therapists who have done specialised training. Mental health professionals accessed through Community Mental Health Services and public hospitals do not charge fees.

 
How do I find the best help?
Use these tips to find and get the best from psychological treatments.

Word of mouth
As well as your GP, ask other health professionals, local pharmacists or trusted family and friends about providers of psychological treatments they would recommend.

Australian Psychological Society (APS)
The APS has a referral service that gives contact details of privately-practising psychologists in your area who work with particular mental health problems.

Ask questions
It’s important to be engaged as much as possible yourself in the psychological treatment. When making an appointment, or during an early session, ask the provider what the goals of treatment are and what it will involve.

Speak out
The more you speak out and are frank with yourself as well as with the person providing the treatment, the more successful it is likely to be. If you feel concerned, confused or uncomfortable with the treatment, let the provider know, so they can work with you to address the reasons for these feelings. If you feel that they are not the right person to help you, then explain this and ask for another referral.

A good provider of psychological treatment will want what is best for you and will not hesitate to refer you to someone more appropriate.

 
How do I find out more?
It is important to ask your doctor about any concerns you have. SANE Australia also produces a range of easy-to-read publications and multimedia resources on mental illness. For more information about this topic see:

-   The SANE Guide to Medication and other Treatments
Explains how all the different aspects of treatment work, by looking at clinical care, medication, support in the community and helping yourself.

To order any of the SANE Guides mentioned on this Factsheet visit the SANE Bookshop at www.sane.org or call 1800 18 SANE (7263).

SANE Australia . . . Psychological Treatments

©SANE Factsheet 24 This Factsheet may be freely downloaded, copied
and distributed on condition no change is made to the contents. SANE Australia is not responsible for any actions taken as a result of information or opinions contained in the Factsheet. SANE Australia is a business name of Schizophrenia Australia Foundation.

[Version English, 2006)