Redbridge Talking Therapies Blog

I’m Ranjot, a CBT Therapist at Redbridge Talking Therapies.

As an individual born in the UK with a British nationality and Indian ethnicity, I have been brought up to speak, read and write both English and Punjabi. This exposure to Eastern and Western culture and upbringing has resulted in me developing a unique fusion of multiple cultural identities. These rich life experiences influenced the way I began to contemplate the similarities and differences in the way people experience depression within Eastern and Western communities.

Unfortunately, my grandmother was unable to speak fluent English, but she and her children would often present with  physical symptoms to their doctor with no obvious medical reason. Particularly, they experienced problems in describing in Punjabi their fluctuations in mood to health professionals who mainly understood English. As I became older and I developed a broader understanding, I began to question how the trauma of my grandfather’s death due to Operation Blue Star in Amritsar, India in 1984, and the subsequent migration to the UK, affected my grandmother and her children psychologically. Once I began my doctoral training in Counselling Psychology, my interest in these difficulties deepened.

Through research, I identified that South Asian women tend to have the highest rates of depression. Yet they are less likely to report their symptoms to professionals as they believe it is an issue they can cope with themselves, it will get better by itself, feel embarrassed to discuss it with someone, language barriers and out fear of being sectioned. This is turn leads to low rates of referrals for psychological support.

Mental health is still considered a taboo subject in the South Asian community. Individuals try to hide their struggles due to potential judgment from other members of the community, out of fear of gossip or protecting their reputation. Despite there being advances in mental health research in the South Asian community, it is still based on Western ideas. Research also highlights a lack of culturally specific assessment tools and specialist service provisions for this community. This led to my passion in developing a new culturally specific assessment of depression in the Punjabi language titled ‘Punjabi Depression Inventory’ (PDI).

My research identified that the symptoms of depression that Punjabi speaking migrants from India now residing in the UK experience, are different compared to their Western counterparts. These symptoms included but are not limited to a sinking heart, feeling sore, body aches, losing interest in attending their holy place of worship, feeling God has lost interest in them and shedding tears.

I believe the solution is education. Firstly, educating the community on the symptoms to look out for, and the support that is available. But also educating health professionals to enhance their cultural knowledge to recognise the difference in presentation. As migration is expected to increase, it is important now more than ever to effectively assess and manage the cultural presentation of depression.

If you, or someone you know, is struggling with feeling low, anxious, stressed or going through a difficult time, contact our free service to find out what support is available. We offer both individual and group treatments with qualified NHS clinicians for anyone aged 18+ and registered with a GP in Redbridge. Our service is confidential, so only your GP and therapist will know about your treatment. Many of our clinicians speak a variety of languages, and we are also able to offer translators for anyone who wishes to speak in their home language.

You can call us on 0300 300 1554 option 1 - Monday - Friday 9am - 5pm

Or you can refer yourself here. 

At first, I was hesitant to join the groups at Talking Therapies. I have in the past only had private counselling and had never spoken openly in a group about my feelings. A group session for treating social anxiety seems like a contradiction. However, without being in a group, I doubt the sessions would have impacted me as much as they did.

I have shared my struggle with social anxiety with my family and close friends, but I have never met anyone who really understood the challenges and what it feels like. During the first session I had, my social anxiety was too high to participate, I just observed, and the counsellors made me feel like that was okay. I wanted to understand the environment and witness how the sessions were run for the first session. Therefore by the second session, I felt it was a safe environment so I could join in.

Both counsellors were excellent, and I felt they knew a lot about social anxiety and could relate to how it feels internally and the types of challenges which are harder to tackle. As a group, we motivated each other to participate in the tasks. I felt at ease when another member of the group shared a thought that I have always felt throughout my experience with social anxiety it made the struggle a lot less lonely. I found the weekly homework and the exposures during the sessions to be really helpful.

The reality of the situation with social anxiety is that you need to put yourself in uncomfortable and difficult situations to get better. Then over time, you become more confident and can identify negative thought patterns which worsen your anxiety. Once I understood this process, it became a lot easier to recognise my thought process, and to dispute these thoughts to calm myself down. All that was due to the teachings of the incredible counsellors who encouraged me to dive deeper into those thoughts and challenge them.

I still do have weekly exposure goals to improve my social anxiety week by week. We celebrated wins as a group and improved together, which was really impactful. Now, when I find myself in a situation that triggers my social anxiety, I think of those I met in the group and the counsellors who would be cheering me on. 

Blog post by Lloyd, one of our CBT Therapists. 

In last month’s article I introduced the topic of goal setting for those feeling overwhelmed and struggling with symptoms of depression and or anxiety. I ended by suggesting you may want to contact our service for further help. However, for many, contacting Redbridge Talking Therapies can be anxiety provoking in itself. For others with depression, it may be a goal which is added to the list of other goals and tasks, which you never appear to get round to. You may procrastinate in asking for help and for others, they may ask, am I even ready for therapy at all?

Therefore, this month I would like to explore what we in the service, as mental practitioners, describe as readiness for therapy. I will use the term therapy within this article, as a capture all term, for a range of psychotherapies and counselling interventions, and whether it be individual or group-based treatments. Put simply, I am going to describe the core ingredients needed to be present at the beginning of therapy, in order, to give you the best chance of recovery or at least provide some reduction in your symptoms. If you are thinking of attending therapy, let us now look at these ingredients which have been found to increase the chance of recovery for those suffering with poor mental health.

It may come as no surprise, as discussed last month, you need to have a specific goal or goals before entering therapy. Ask yourself, what is it I want to achieve by engaging in therapy. Maybe you want to be more assertive or be able cope with attending social events which may be causing you anxiety. For some people with specific conditions, like Obsessional Compulsive Disorder (OCD), it may be to reduce handwashing throughout the day, and only wash your hands when it is completely necessary. For others with general anxiety, it may be to reduce your worry throughout the day and then actually do something about the worries. If you are having difficulty finding goals for therapy, and your thoughts just lead you to wanting to feel better, ask yourself, what would I be doing if I was not suffering with depression, anxiety, or a specific condition? The answer is likely to be your goal or goals for therapy.

The next question to ask yourself is can I commit to regular therapy sessions? If you are found to be suitable for a talking therapy, dependent upon the level of intensity and type of therapy, you will be required to attend on a weekly basis for between 30 minutes to up to 2 hours. Although we generally offer between 6 to 12 sessions, your mental health practitioner may suggest more sessions, or that you return to therapy at another time to complete more work on other problems or symptoms. Put simply, there is a regular time commitment required.

Regular attendance of the appointments is not the only commitment required. A willingness to work on your problems, and a commitment to work on your difficulties outside the sessions is also needed. Many of the approaches we use in therapy require you to carry out homework between the sessions. The term homework may scare some people. However, it is the term mental health practitioners use for tasks which many involve monitoring your everyday thoughts or behaviours and then practising new ways of thinking or carrying out new behaviours during the week. Homework is likely to be specific to you, your goals and is likely to be challenging. Remember nothing which was ever worthwhile in life was easy. This said, you and your therapist will discuss and agree on the homework and will start with very easy tasks. Even if the homework appears easy at first, completing it, still remains a core condition of therapy.  

The next ingredient for successful therapy is very subtle, but nevertheless, is central to your success in therapy. This is being prepared for therapy sessions. I have discussed homework, which is part of the preparation, and attending at a regular time. However, you will be required to complete weekly questionnaires before the start of each session. Most of questionnaires are technically referred to as psychometrics; these are psychological measures of symptoms which we use in the NHS, and which have been validated through many years of research with thousands, if not hundreds of thousands of people. Your therapist is trained to read them, then adjust your sessions accordingly, which make them an essential part of the therapeutic process. They can take up to 10 minutes to complete each week, if they are not complete before the appointment, it will eat into the therapy time and affect the course of your treatment.

By now, I imagine some people may be reading this and thinking, this talking therapy sounds a bit like hard work! It may sound offer putting at first, especially when you are struggling with your mental health. Nevertheless, I can sum up the ingredients required for successfully therapy in two works, personal responsibility. No matter how experience, trained, qualified or skilled your therapist, if you struggle to attend, and are not completing homework outside of sessions. Then spending the first 10 minutes of the session completing questionnaires, you will be facing an uphill challenge. If any of these behaviours continue to be present in therapy, it may suggest you are not ready for therapy at this time.

Additionally, successful therapy is teamwork, between you and your therapist, which demands commitment by both parties. For example, I regularly ask people I work with to email their homework before the appointment, which I then read, and it helps me to prepare the sessions. Although therapy may feel a little dauting after reading this article, please remember as therapists we will always work within your capabilities. As part of the initial telephone assessment, we will gauge the appropriate level of therapy for you, which is likely to bring about the greatest success. For many, therapy is the development of the skills over time and clients can increase their commit to more intense therapies at a later date. Therapy is a process and is not about pass or fail, it is simply about giving it a go!

If you feel you may be ready or if you are unsure if you are ready for therapy, but want to discuss your options further, please contact the service on 0300 300 1554 option 1 or if you prefer you can self-refer online at https://www:talkingtherapise.nelft.nhs.uk/redbridge

Just recognise by contacting the service, you are actually showing personal responsibility and a commit to bring about a change in your life.