Help with most problems, including depression, anxiety disorders (panic attacks, agoraphobia, social phobia, obsessional-compulsive disorder, post-traumatic stress disorder), physical problems such as irritable bowel, chronic fatigue, relationship and sexual difficulties, Asperger’s and autistic difficulties, binge-eating and weight problems, stress-related and work problems, life review and planning. Cognitive behaviour therapy (CBT) has the best evidence base of all the therapies for many of the above problems, particularly anxiety and depression. It is recommended by UK national government guidelines and the National Institute of Clinical Excellence (NICE). There is little direct evidence about providing CBT by e-mail, but we know it works when people interact with programs on CD such as ‘Beating the Blues’. This e-mail approach has been piloted for several years and found to be practical and useful. CBT involves working hard, together with your therapist, to understand what is keeping the problems going, and to practice changing the way you think, feel and behave around the problem. There is homework to do between sessions and usually diaries to keep to record thoughts, feelings and behaviours as well as physical symptoms and reactions. Research shows It is most important that you are prepared to do these tasks in between sessions to gain the benefit from CBT. Most problems can be dealt with in 6 to 10 sessions, though sometimes more (up to 20) are needed. The therapist and client contract for a number of sessions (usually 6 in the first instance). During this time both people monitor progress and review how things are going. If progress is satisfactory 4 more sessions might be agreed, if necessary. Ideally, sessions should be weekly at first, certainly not more than fortnightly, because impetus is lost. A ‘session’ is an exchange of emails (up to 2 pages) between therapist and client. This feels rather like writing a letter in an old fashioned way, so if you have ever experienced such a thing you may like this way of doing therapy. Advantages include having time to think and reflect on what you’re saying and being able to change this before you send it. The therapist can do the same with what they send. This means quite a lot of information is processed by the brain whilst working out what to say and how to say it, and information processing is good for problem resolution. Another advantage, if required, is anonymity. Your therapist does not need to know your real name and for added security you may wish to use a pseudonym in the e mail exchanges. You will also have a written record of everything that has been said in the therapy and can go back to this whenever you need to. You may travel a lot, or live in a different culture and wish to work with someone from your home culture. We often feel this need when struggling with personal difficulties. E-mail therapy means you can stay in touch wherever you are, and communicate at a time which suits you. Whatever the time zone, you don't need to make an appointment. Disadvantages include not having an instant, reactive exchange with your therapist as one could in an online chat environment. Also, no internet therapies allow therapist and client to see or hear each other, though voice over internet protocols and webcam use will become much more available soon in this context. This treatment approach is not suitable for anyone who is, or has been, suicidal, or who has severe mental health difficulties. You will need a treatment team of mental health professionals around you to help manage situations. Obviously, e mail contact is not enough to provide this. Please visit links section for organisations that can help you further. |
"thank you for helping me to sort out my relationship, I didn't believe I could be so clear in what I wanted and so even-handed in achieving it. Now it all seems so easy! I'm sure there will be more struggles in life, but I feel better equipped to deal with them."
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