Talking and other therapies for young people experiencing psychosis

Talking therapies include one-to-one (in person, over a telephone or online) and group sessions with a person qualified in a kind of psychotherapy or counselling. Therapy could be:
  • more structured sessions based on varying ideas of psychotherapy (such as Cognitive Behavioural Therapy – CBT)
  • less structured and provide a space to just talk about things like feelings
  • group therapies with other young people, or
  • family therapy.
Some people we spoke to had been offered talking therapies for depression, low mood and anxiety during their childhood or when they first experienced psychosis.

Nikki has had support from a range of services. Dialectical Behaviour Therapy helped her to manage emotions and this helped her manage the voices she hears. She’s found charities most helpful because the staff aren’st time constrained.

Age at interview 19

Gender Female

View profile

People also mentioned a range of different talking therapies including CBT, Dialectical Behaviour Therapy and counselling.
  • Cognitive Behaviour Therapy (CBT) is a form of psychotherapy that gives people techniques to manage and change their response to thoughts and feelings.
  • Dialectical Behaviour Therapy (DBT) is a form of CBT that aims to help people accept themselves, deal with intense emotions and improve skills in relating to others.
CBT and DBT usually involve a short number of very structured sessions (6 to 8 typically) and can be done in groups, whereas counselling (sometimes called psychotherapy) can continue for longer and provides a space for people to talk on a one to one basis with a trained professional to explore their deeper thoughts and feelings. You can read more about different types of talking therapy on the Mind website.

Getting a referral

Talking therapies were arranged through a school or college nurse, GP, Child and Adolescent Mental Health Services, Early Intervention in Psychosis team or a charity such as Mind. Getting a referral can take some time. Some people mentioned long waiting lists and missed opportunities due to staff errors. Emily has been on a waiting list for DBT for 2 years. Ruby never received her appointment letter for talking therapy because her dad had told her to leave home and she was ‘sofa surfing’ when it was sent out. But Becky was seen quickly once her referral was processed.

Becky had a good experience of starting therapy only days after a referral, but also experienced long waiting times for talking therapies. She talks about the difficulty of coping while waiting for therapy.

Age at interview 24

Gender Female

Age at diagnosis 20

View profile

The benefits of talking therapies

Talking therapies often include learning practical strategies for managing mental health as well as the opportunity to gain greater understanding of, and control over, thoughts, feelings and distressing experiences. Sometimes just having an opportunity to share feelings with somebody can be a relief. Joe learnt to think about his voices differently during CBT sessions. Now he understands the voices better and no longer sees them as the ‘big, scary voices appearing out of the dark’.

Peter went to group therapy sessions. He describes a session where they were told to accept intrusive thoughts and instead of challenging them, to let them pass through.

Age at interview 24

Gender Male

View profile

Dominic describes how one really good CBT therapist worked intensely with him to understand the self-hatred and anger that feeds into his psychosis and give him tools to cope.

Age at interview 24

Gender Male

Age at diagnosis 21

View profile

At first Luke didn’st enjoy his CBT sessions but he now looks forward to them. They help him find out more about himself.

Age at interview 21

Gender Male

Age at diagnosis 19

View profile

Group therapies provide an opportunity to talk and hear about (and learn from) the experiences of other young people. For some people we interviewed this was the most helpful because they felt less alone. However, if the person’s experiences were quite different to others attending the group, it could leave them feeling worse.

Lucy experienced psychosis after a head injury. She was referred by her GP for general group therapy sessions for depression and anxiety, but the other people attending had relatively mild depression.

Age at interview 22

Gender Female

Age at diagnosis 21

View profile

Factors affecting the experience of talking therapy

The timing of the therapy, and level of expertise of the therapist was important to people we spoke to. Some who had therapy very early on in their experience of psychosis said they didn’t benefit from it. Counselling that young people received through their school in particular tended not to be specialised enough. Andrew X and Tariq both had counselling in school after bullying led to a breakdown. Andrew X felt he needed more than just talking and would have preferred to have been referred for help from a psychiatrist. Tariq found the techniques that the counsellor suggested to help him deal with his anxiety, such as mindful breathing, didn’t help and he began to feel suicidal.
Well-meaning support from people in the community who did not have the training or skill to help with psychosis was also sometimes unhelpful. Lucy’s church assigned her a pastoral care worker who was a trained counsellor, but who didn’t have the skill to help with psychosis, and she didn’t feel the sessions helped her.
But those who had a lot of experience of psychosis could find talking therapies helped them to get some better understanding of why it was happening, and this was helpful.

Becky has found CBT really helpful but didn’st find other talking therapies she had previously had worked as well. She thinks maybe there is a time and a place for the right therapy.

Age at interview 24

Gender Female

Age at diagnosis 20

View profile

Finding the right therapist was very important. A few people mentioned the difference between therapists who were following a ‘process’ and those who tailored the sessions to the individual. For Andrew X the best therapists just allowed him to talk and used CBT to help with what came up. Finding a therapist who seemed to genuinely care about them was also important for some people and this could take time.

Dominic had two therapists who he didn’st get on with. Eventually he was referred to a psychologist who invested in his story.

Age at interview 24

Gender Male

Age at diagnosis 21

View profile

Some of the people we spoke to didn’t find talking therapies helped them or didn’t want to try it. A few felt that counselling always focused on the negative and could make things worse, while others were worried it would bring up unpleasant memories. Chapman, who is seeking asylum in the UK, was offered counselling but turned it down because he was concerned it might ‘bring back stuff’ from his past in Zimbabwe which he wanted to forget. Andrew X thinks only being offered 6 sessions of CBT can be damaging because it opens a ‘Pandora’s box’ but doesn’t allow time to deal with things properly. Fran doesn’t like counselling and thinks therapists ‘invent problems’ which aren’t there. However, she has found books on CBT helpful in giving her practical tools (see below).

Hannah saw a therapist for a year for anxiety and low mood. She said they focused on her childhood whereas she didn’st think there was anything problematic in her past.

Age at interview 19

Gender Female

Age at diagnosis 15

View profile

People sometimes found other ways to tell their story or work through things: such as art or dance therapy, journal writing, writing poetry or using techniques such as mindfulness, and a few had posted blogs or video diaries online. Many also engaged in peer support work, often as volunteers, and found talking to others with similar experiences helped. Some talked about the benefits of talking with friends and family or other mental health workers such as their carer. Luke finds his Social worker is able to understand him as a person and prefers talking to him than to his psychiatrist. Dominic has a great relationship with staff at his local Mind centre and can call there and just have a ‘rant’ if something is on his mind.

Medication for psychosis

Most people had been prescribed a number of different medications over the time they had been having psychotic experiences. These included: Anti-psychotics (e.g. olanzapine, risperidone,...