"A very useful programme, but face-to-face therapy unhelpful"

About: Nottinghamshire Healthcare NHS Foundation Trust / Adult Mental Health Services - Community (County)

(as the patient),

Silver cloud is a fantastic idea and I found it very useful. Whilst much of the programme is what I would consider to be common sense the mindfulness exercises are helpful and the tasks on the site encourage you to put the ideas into practice.

In my opinion the site has been well thought out and is effective in its aims. I found using a journal both on and off the site to be a great tool in releasing tension and anxiety but I remain unsure as to whether the journal on the site was intended for this purpose – if it isn’t, then it should be.

The staff member was consistently pleasant if not occasionally patronising. However, I am aware that interpretations of written text can be wide in range and on the whole I feel they did a good job in my case. Knowing that someone is checking your usage of the site on a regular basis is an incentive to complete sections as well as a great way of giving the feeling of being supported.

My feelings towards Silver cloud and the staff member are positive and I would recommend the programme to anyone suffering with anxiety – with or without having a counsellor attached (it could work as a programme to work through alone).

My experience of face to face therapy was the opposite of positive and helpful.

The back of a library in a room of which you can hear goings on from the outside is not appropriate for the purpose of CBT.

The therapist also set the room out as if for an interview process before proceeding to ask probing questions. The layout I found puzzling considering the intended purpose. The first thing of which they notified me was that they had not bothered to access my notes but had instead made a quick phone call discovering I had depression and anxiety disorder. They then thought it acceptable to lock the entrance/exit door, an act I find particularly bizarre considering my ‘anxiety’.

After some ‘therapy’ which I found helpful, useless and patronising in equal measure (I would also like to add here my objection to typing up notes during therapy) I decided I did not wish to continue.

The therapist then did the following things which I felt to be inappropriate:

- Blocked my exit

- Enquired as to why I looked ‘tense’

- Repeatedly instructed me to ‘sit down’

- Hugged me

- Informed me that they would discharge me if I were to leave

- Informed me that I would relapse if I were to leave

To conclude, I found my experience of face to face therapy to be somewhat traumatic and it has definitely made me reluctant to try such ‘help’ in the future regardless of my possible needs.

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Response from Nottinghamshire Healthcare NHS Trust

Thank you for your feedback. There has been a lot of thought put in to these comments, so I am grateful for the time spent on this.

I agree about silver cloud – trying it out personally as training before using it as a tool at work has convinced me of its usefulness.

I see there are some themes of staff attitude – being patronising, probing, and some meaning taken from actions, body language, choice of words, and style of session.

I am always sorry to hear that someone isn’t getting what they benefit from using the service. We have been looking at putting feedback directly into staffs’ appraisals. Perhaps more of our sessions should be videoed and taken to supervision.

There are three other trains of thought for me reading this

1/ Hugging, locking the door and standing in someone’s way are not ok and should not happen in a primary care psychological therapy session.

2/ I would want to have a look at that venue – we have to be creative about clinic space sometimes, - aiming to be more accessible, but it’s still got to be fit for purpose.

3/ The other points leave me with more questions and wanting to talk it through, so I would really want to encourage this person to contact me or another leader in Let’s Talk Wellbeing so we can help and/ or learn in this situation.

That may sound a bit vague; I suppose I was thinking about how the laptop was used, what else was said about the purpose of the session, when and why we discharge patients, how both this person and the member of staff prepared for the session.

We appreciate you taking the time to share your comments as this is the best way we can improve our services

Should you wish to talk this through please contact Dave Young at 0115 9560888 or alternatively you can email us at letstalknottingham@nottshc.nhs.uk