Alternatives to psychological therapies

Animal-Assisted Therapy – www.scas.org.uk/

animal-assisted-interventions/accreditation-and-qualifications

Horses, dogs, cats, goats and even chickens are being utilized as part of outdoor therapy approaches which have nature and connec- tion at their heart. The science of social connection and attachment supports this approach as our bonds with animals can provide us with many benefits psychologically.

Art Therapy and Art Psychotherapy – www.baat.org/ About-BAAT/What-we-do

Art therapy/art psychotherapy (the terms are used interchangeably) is a state-regulated profession in the UK. Art therapists are regulated by the HCPC, so only a therapist with the appropriate training and registration can call themselves an ‘Art therapist’. Art therapists are practising artists who also have training in psychotherapy – usually with a psychodynamic focus. It can be a very powerful non-verbal approach. Have a look at some of the comments from people who have experienced the approach here: www.baat.org/About-Art-Therapy/ Art-Therapy-service-users-share-their-experiences.

See also Sensorimotor Arts Therapy – http://www.sensorimotorart- therapy.com/sensorimotor-art-therapy

Autogenic Training – www.autogenic-therapy.org.uk and www.autogenictraining.org

Autogenic training involves sets of repetitive exercises in combina- tion with the assessment and feedback of what is happening in the body. It’s aim is to promote mindful relaxation and stress reduction.

Bibliotherapy, ‘the Ancient Art of Book-Healing” – www.relit.org.uk

We don’t just read for pleasure. We read to understand, to learn, to be surprised, to find hope and to feel a bit less alone in the world. Reading and listening to stories can enrich our lives in so many ways. Being part of a book club helps us share stories and feel connected with others, and reading for wellbeing is also part of this movement towards harnessing the power of reading.

Here are some of the organizations and projects that are involved in bibliotherapy:

Books on prescription – reading-well.org.uk/books/ books-on-prescription/mental-health

The ‘Overcoming’ series – overcoming.co.uk/14/Help-for-Mental-Health

The Emergency Poet – emergencypoet.com/about/ and The Poetry Pharmacy – www.poetrypharmacy.co.uk/

The Poetry Pharmacy – A book by William Sieghart, founder of National Poetry Day and the Forward Prize. – www.penguin.co.uk/ authors/132348/william-sieghart.html?tab=penguin-books

Quiz – ‘What is your poetry prescription?’ www.penguin.co.uk/ articles/2017/poetry-pharmacy-quiz

Shared reading – www.thereader.org.uk/what-we-do

Biofeedback, Heart-rate Variability (HRV) and Neurofeedback

Psychophysiological methods are starting to be utilized by some psychotherapists. Advances in neuroscience are indicating potentially exciting avenues of integration between the brain and body, and between our relationships, environment and psychological functioning.

Blended Therapy

Blended therapy is where you have the support of a therapist or wellbeing practitioner whilst completing certain therapy modules online. You will have an assessment of what you are struggling with and the therapist will help you to set some goals for what you hope to get out of the sessions. The therapist will then help select relevant modules for you to work through and you will have review sessions to talk through how you are getting on. SilverCloud is a programme that is often used in blended CBT practice.

CBWT – Cognitive Behavioural Writing Therapy

CBWT was developed by Arnold van Emmerik as ‘Interapy’ and was later expanded to Internet-Based Cognitive Behavioural Writing Therapy (IB-CBWT). As a technique it is a combination of expres- sive writing therapy, trauma-focused therapy and cognitive behav- ioural therapy for trauma. In a multi-centre randomized controlled trial in 2017, it was found to be as effective as EMDR for children between the ages of 8 and 18. (Roos et al., 2017).

Cyber Therapy

This is a name that is synonymous with ‘online therapy’. There are several training courses for therapists to gain skills in online working. Some use the term ‘online therapist’ whereas others use the term ‘cyber therapist’.

Dance and Movement Therapy – admp.org.uk

Dance therapy involves helping to regulate feelings using the move- ments of the body. It is an integrative practice that uses the medium of the body rather than talking.

Dramatherapy – badth.org.uk

Dramatherapists are artists and clinicians and dramatherapy is the therapeutic use of theatre and dramatic arts as a psychological therapy. It makes use of a range of artistic mediums such as pup- petry, mask work, story and improvisation.

Expressive Writing Therapy – See Writing and Wellbeing

Hellerwork Structural Integration – hellerwork.com/ what-is-hellerwork

Hellerwork is a body-based method of structural integration that aims to integrate body, mind and movement.

Holistic Therapies

This book is about psychological therapy, which is focused on the use of psychological theories to help people who are struggling with their mental health. I have not been able to include the vast array of holistic therapies that are available, although it is fair to say that many of these have psychological effects. If you are looking for a holistic practitioner, the Complementary and Natural Healthcare Council (CNHC) provides an independent register of complementary healthcare practitioners (www.cnhc.org.uk).

Journal Therapy – See Writing and Wellbeing

Music Therapy – www.bamt.org/music-therapy/what-is-music- therapy/mental-health-care.html

Through improvised music rather than talking, music therapy can be an aid to feelings and help people to communicate in alternative ways to traditional talking therapies.

Online CBT

Text-based, Synchronous Instant Messaging

The traditional face-to-face, one-on-one therapy model has been shifting since 2010 but has accelerated in the last five years. COVID- 19 restrictions forced many therapists into online and phone ses- sions with clients; however, a substantial number of therapists were already working online. The company IESO (formerly Psychology Online) has been offering text-based, instant-messaging therapy since 2014. The client and therapist communicate by typing into an instant message chat screen.

Online Programmes – Asynchronous (work through it in your own time)

Other companies such as SilverCloud also offer online CBT modules to clients. SilverCloud offers a series of self-contained programmes that you can work through. For example, CBT for depression would take you through a series of modules all based around different CBT strategies, such as thinking patterns, core beliefs and how they affect us, and behavioural aspects of depression.

In the NHS these online CBT modules are routinely used in practice along with telephone therapy, video therapy and the newer virtual reality therapy.

The  MIND  website  lists  other  programs  available as alternatives to SilverCloud: www.mindcharity.co.uk/ online-self-help-programmes-websites-resources.

Email and Message App Therapy (Asynchronous, not an instant reply)

There are also some therapists who offer text-based therapy via email or messaging apps such as Signal.

Outdoor Therapy

Ecotherapy – www.goodtherapy.org/learn-about-therapy/types/ econature-therapy

Ecotherapy is a generic term for doing therapeutic activities outside in nature and bringing nature into the activity in some way.

Gardening, nature-based and community conservation for wellbeing projects

farmgarden.org.uk tcv.org.uk/greengym groundwork.org.uk thrive.org.uk carryongardening.org.uk

Forest Bathing – foresttherapyinstitute.com and natureandforesttherapy.org

Also known as shinrin yoku in Japan, where it originated, ‘forest bathing’ is the term we now recognize as referring to walks in nature, in woods and forests. A large body of research has been and is currently still being carried out on the exact reasons why this is beneficial to our health, but it is being shown to have significant benefits. Even a 20-minute walk in green space is enough to make a difference.

Natural Mindfulness – natureconnection.world/category/natural-mindfulness

Mindfulness guides use nature to support mindfulness practice. The website above also lists ecotherapists and forest bathing practitioners.

Outdoor sports and Wilderness therapy – www.blackdogoutdoors.co.uk and waveproject.co.uk

Wilderness therapy projects such as ‘Black Dog Outdoors’ aim to use outdoor activities and sports such as climbing, paddleboarding and biking as not only forms of exercise but ways for people to connect and be supported by others.

Phone Therapy

As we saw above with email and instant messaging, therapists have been adapting the way that they work, and phone therapy is another alternative to face-to-face therapy. It is often used by Employee Assistance Programme providers of counselling services and for CBT therapy as well. It can work effectively for some people and I have experience of this proving to be beneficial to clients. The key here is finding the method that works for the person and not assuming it will work for everyone.

Running and Walking

Dynamic Running Therapy (DRT)

A blend of mindfulness, walking/running and talk therapy along with psychoeducation on anxiety and depression. Developed by William Pullen.

ParkRun – www.parkrun.org.uk

Free, weekly meetups for people to walk, run or jog and join with others. There will be an agreed distance but participants are free to either walk, jog or run.

Walking for Health – www.walkingforhealth.org.uk

Another project which aims to connect people and improve wellbe- ing by taking part in walks together.

Hip Hop Therapy (HHT) – www.hiphoptherapy.com

HHT utilizes hip hop as a therapeutic medium to heal.

Safe and Sound Protocol – integratedlistening.com/ ssp-safe-sound-protocol/

The Safe and Sound Protocol is a headphone-based programme that is designed to reduce stress and auditory sensitivity while enhanc- ing social engagement and resilience. It was developed by Stephen Porges, the creator of polyvagal theory.

Sound Therapy and Sound Baths – www.britishacademyofsoundtherapy.com/what-is-sound-therapy/

Sound therapy involves the use of sound from specific instruments to influence brain waves and the person’s autonomic nervous system.

Tension and Trauma Release Exercises (TRE) – traumapreven- tion.com/what-is-tre

TRE is a set of exercises that are designed to assist the body in releasing pockets of stress, tension and trauma.

Somatic Stress Release – www.drscottlyons.com/about

These are body-based stress release techniques devised by Scott Lyons.

Virtual Reality and Augmented Reality Therapies

VR headsets and other wearables that connect via Apple Watch, for example, can provide information on internal bodily signals such as blood pressure, heart rate, heart rate variability, muscle tension and breathing rate. Virtual reality headsets are currently being used in some NHS services to help clients with phobias and psychosis. This therapy works on the principles of exposure therapy as part of CBT and helps clients to gradually feel less threatened in situations that they would usually avoid or feel overwhelmed in. Here’s a link to several studies carried out by the department of psychiatry at the University of Oxford:

www.psych.ox.ac.uk/research/oxford-cognitive- approaches-to-psychosis-o-cap/projects-1/ oxford-virtual-reality-vr-for-mental-health

Voice

The Naked Voice Foundation – www.thenakedvoice.com

Founded by Chloë Goodchild, this is a programme of exercises and techniques to help you discover your authentic voice.

Voice Dialogue – www.voicedialogueinternational.com

A psychospiritual therapy using voice to contact the many selves within us.

Voice Analysis – www.healthoptimising.co.uk/assessments/ well-mind-assessment

The Voice Analysis system aims to pinpoint patterns in your speech and identify emotional issues that can be targeted and resolved.

Writing and Wellbeing

Writing has become an important addition to wellbeing activities. Talking is about putting experiences into language and making meaning. Writing is also about translating experiences into language, but in a slightly different way, and it can be just as beneficial as talking. We can see this in the research into expressive writing. This area is also called ‘therapeutic writing’ and ‘journal therapy’. It also encompasses ‘poetry therapy’. In the UK, Lapidus is the main membership organization for practitioners of writing and wellbeing (www.lapidus.org.uk). There are also degree courses in therapeutic writing offered by the Metanoia Institute and the University of Sussex.

Expressive writing is the use of writing about emotions and emotional experiences, as a way to offload, release or disclose rather than suppress one’s feelings. It is also a method that helps to make sense of what we feel and process difficult experiences. The ‘expressive writing’ paradigm is said to have begun with the work of James Pennebaker in 1986. One of the standout findings was how participants’ immune responses changed after writing. Pennebaker attributed it to what he termed ‘disclosure’. He found that when people disclose certain experiences, they process the associated emotions and engage in meaning making about the event, which helps to reduce distress.

This is very similar to what happens in psychotherapy, in particu- lar trauma therapy. But writing can be a helpful addition for those who find talking difficult. Handled in the correct way, the therapy should be about safe, grounded containment, learning self-regulation skills, then processing stuck emotions and negative meanings to come to a new understanding. Emotions are multisensory events too; for example, they are the actions or unfinished actions of muscles in the body, a rise in blood pressure as the body readies itself for action. The processing of emotion in psychotherapy is a physical process, not just a cognitive one. This is described in exquisite detail in Bessel Van der Kolk’s book The Body Keeps the Score (Van der Kolk, 2014).

Yoga Therapy

Yoga is being used frequently by some trauma-therapy centres, particularly in the US, and an evidence base is beginning to grow for its effectiveness in soothing and balancing the nervous system. An example of yoga in a therapy setting is trauma-sensitive yoga: www.traumasensitiveyoganederland.com.