Compulsory CBT?

28 July 2014 - 14:17

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Hi Grams & Others

This post is about Gram's idea of starting a thread about how CBT could be improved. He suggested the idea in another thread about how to make best use of professionals whilst undergoing CBT. I think this will become an important issue in the context of a Daily Telegraph report on the 13 July 2014 that the government is thinking of making it compulsory that people will have to accept therapy if they are to receive benefits such as ESA and are diagnosed with anxiety or depressive conditions. According to the article the plan consists of on line therapy in addition to face to face therapy as well as connecting back to work sessions with therapeutic interventions. I have no experience of on line therapy and feel it would be interesting if there were comments on the effectiveness of such approaches. 

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28 July 2014 - 23:07

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Hm.  Not sure I like the sound of this.  Good idea in theory, but if the therapist you're allotted turns out not to know about OCD, or just not to get along with you, and makes matters worse, will there be any kind of a provision for that or will you have to keep going or lose your benefits?  It does quite often happen, psychotherapy being such a personal thing.  Anyway, I know that wasn't what the thread was supposed to be about, sorry Check.

29 July 2014 - 13:27

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Many thanks Check for starting the thread, hoping you and Wombat are doing okay.

I think one the difficult things when in therapy might be when you are trying to express yourself but you can't quite get the right words out. The therapist will probably know this and try and encourage you to open up a bit more, One thing that got me thinking was is this the right approach going for CBT therapy or mainly focussing on the exposure and response prevention techniques. I'm thinking that we need a combination of both the reason being I believe we tend to have a lot of negative thoughts so in a way the CBT might be covering that aspect of it while the exposure part is tackling the ocd part head on.

Maybe it's technically being practiced but my idea would be to allocate time for both therapies but give the person the option whether they want to try the exposure therapy as this can be hard.

This will be an interesting thread.

29 July 2014 - 18:42

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Years ago when you signed a sick certificate you were signing to say amongst other things that you would not do anything to impede your recovery. This would have included refusing to engage in any beneficial treatment.

Regardless of the DWP etc we each owe it to ourselves to try any reasonable and appropriate treatment offered in order to regain our lives. And as I was taught "If one doesn't work, then try another".

I have no personal experience of online therapy for anxiety and depression but have heard many good reports about it.

30 July 2014 - 14:08

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I think that the devil is in the detail, Wombat. I got to hear about the article from a feed from a organisation which provides support and structured work experience for people with mental health problems.  It is an international organisation which has some centres in the UK. Their programmes include temporary work experience where members are employed in companies at the going rate for the job. It was reported that members of this organisation had some concerns about the proposal given the general lack of provision in back to work schemes and the proposed target that 90% of claimants with anxiety and depressive conditions would cease to claim benefits. 

I thought, Grams, that in the context of the first proposal to have semi compulsory treatment for people with a medical diagnosis outside the context of compulsory treatment of patients under certain Sections of the Mental Health Act merited consideration. And that as patients or consumers of treatment we merited some input into how treatment could be improved. I would like to identify good practice as identified by Truddles and ensure that these good practices become the norm. I experienced truly excellent CBT conducted by two therapists and one experience of CBT by a therapist who did not follow standard procedure and systems of CBT with for example no homework. Unfortunately at the time I did not have the knowledge of what constituted good therapy. Truddles had done a good job of indicating of what it consist of. It is interesting that the good experience was in the context of an institution which periodically collected questionnaires from patients on their experience which were collected by a third party. This has been standard practice in a number of organisations for a number of years including the university sector and facilitates a continuous improvement in quality. In fact our therapists would have been trained in organisations which follow this practice.

Do you mean Grams that patients should have a choice between either cognitive or behavioural treatment? I personally would be against this as it was in my case the behavioural treatment was the precursor to the cognitive part of the treatment as my habits had become so deeply entrenched. At one stage it took a couple of days even to leave my house. It was my some resistance that I stopped intense checking but I glad I experienced the discomfort.

30 July 2014 - 17:50

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Hi there. My main concern would be if the therapists were up to the job. We have heard where government 'schemes' go wrong, and that could lead to people getting worse in their condition. The therapist/client relationship is a very special one, needing a great deal of trust on both sides. Both need a willingness to negotiate the path of treatment. If the trust isn't there, then the therapy wont work properly. I can see that they probably mean well, but the wrong help can put us behind with  our progress. There was a scheme where we could be employed with support, but I guess companies couldn't spare the staff to provide support. Another thing that seems to have come unstuck is charity shops. I'm hearing of cases where the shops have to take benefit claiments on placement, so they don't lose their benefits. This clogs up the system where it is getting difficult for the rest of us who are seeking to work in charity shops. I'm getting psyched up to trying work in a charity shop after holidays, when I can see what hours I can do. No one wants to suffer all the time, work would be a good therapy for many of us, but it's getting the support...

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30 July 2014 - 19:59

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Getting better and fighting this thing in our head is wat i thought this forum was about not goverment 'schemes'etc get a life or a hobby or somthing ! Or get into politics! As to online therapy i think its prob better to see a good therapist .

30 July 2014 - 21:04

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These forums are here for us the forum users to discuss anything pertaining to OCD provided that it doesn't break site rules and community standards and I don't believe that this topic breaks either.

It is a topic that is currently in the news and therefore our views are important. Having said that the majority of people using these forums are already either engaging in treatment or are actively seeking treatment so even if the powers that be decided that for this exercise OCD would still be classed as an anxiety disorder they wouldn't be affected this.

31 July 2014 - 11:13

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Hi Check, Hi everyone

Quote:
Do you mean Grams that patients should have a choice between either cognitive or behavioural treatment?

I must stress that CBT is extremely important as in a way it teaches us how to restructure our thoughts but the exposure part might be more difficult to undertake especially if our ocd is very severe, by all means I would encourage the exposure part. Now thinking back to the question that Check was asking, I think we should have more of a choice with what side of things you want to focus more on but the other part of me says we certainly need guidance in deciding what therapy we should focus on more.

In certain cases I kind of believe that we might have to focus more on the depression or the conditions that accompany ocd, one example might be when someone is feeling suicidal it might be better to tackle the underlying thoughts that are causing this. (I could be wrong but I have sort of a feeling that was the main area we focused on what hobbies do I have, what do I do when the thoughts get too much (etc).

I don't think forcing people to have therapy is good because we need to want to engage so in a way the government might not be going about this the correct way, I can understand but if someone thinks he or she is okay it might seem slightly patronising to suggest that you absolutely need to undertake therapy.

I don't believe we should force anybody to undertake therapy but we must encourage and I think there's a massive difference between the both.

4 August 2014 - 14:06

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Hi Grams

Very difficult to have hard and fast rules about therapy. Different approaches for different people and the rapport between the therapist and client is very important. I think the approach taken should be negotiated and by approaches I mean things like the extent and intensity of the exposure. 

Hope you are feeling better. You mentioned in other posts that you felt under the weather.

4 August 2014 - 16:52

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Hi everyone,

As I understand it, the government's idea of forcing someone with OCD to have therapy would only apply if the person with OCD wants to claim state benefits due to not being able to work and earn a living. I personally feel this is fair in principle because state benefits are a privilege and not an automatic right. It is one of the perks of living in the UK instead of in, say, Poland or Bangladesh. Because overcoming OCD through therapy is usually a formidable and daunting ordeal demanding great courage and often casusing short-term anguish, it is understandable that many people with OCD might settle for the easier option of living with their condition untreated and letting the state support them. If someone with a physical disability expected the state to support him because he was physically unable to do a job, it seems reasonable that he should first be examined by a doctor and be expected to try whatever treatments are available before the doctor certifies him unfit for work. I think it is the same for people with mental illnesses.

In practice I hope the government would not stipulate too precisely which type of therapy a claimant must undergo before being awarded benefits. I hope each person would be dealt with as an individual and would only be expected to try whatever type of treatment(s) are deemed suitable to his/her unique condition and circumstances, instead of the government imposing a one-size-fits-all rule on everyone.

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