A case study from our Talking Therapies project with Second Step
Second Step provide 6 sessions of one-to-one cognitive behaviour based talking therapy in older people’s homes, for those who are unable to access therapy elsewhere because of physical or mental health needs.

A participant’s story:

Lisa was referred to Second Step by one of the Bristol Community Navigators as she was experiencing depression and anxiety.

When I first met Lisa she was isolated and didn’t leave the house very much. She was keen to participate in more social activities but felt her physical health was a huge barrier for her. She suffers with Pustular psoriasis on her hands and feet as well as arthritis in both knees. Both of these cause her a lot of pain and mean that she cannot walk for long distances. She had been smoking more than usual due to worries about her health and about her family.

Over our sessions together we worked on her worries and her social anxiety by recognising unhelpful thinking patterns and finding alternative ways of looking at things.  We looked at relaxation methods and Lisa tried breathing techniques and hobbies such as knitting or colouring. Lisa was very focussed and committed to making changes and so she threw herself into everything we discussed and started to find herself able to relax more. She started to let go of worries regarding other people and things that were out of her control.  We use our own scores for depression and anxiety and by the end of therapy Lisa’s scores had reduced drastically.

In her feedback Lisa said, “Anxiety had taken over my life. I wasn’t going out before I spoke to Second Step. It’s just nice to be able to talk and know you’re not alone. You can’t talk like this at the doctor’s because they don’t have the time but the people at Second Step are wonderful. The people that come to your house seem to have a good understanding of what you need. It’s made me more aware of myself, I just have to put my mind to it and slow and sure, I feel able to go down to the shops.”

I have recently got back in contact with Lisa to complete a 6 month follow up and she told me that a health scare had put her back a little and she spent a short time not leaving the house after an operation. However, this time Lisa was able to get herself out of this and challenged herself to go to the local shops. This gave Lisa some of her confidence back that she can do this for herself. I have researched some activities in Lisa’s local area and she is hoping to attend an art group and a social meeting in the future.


Impact and Learning:

While working within this project therapists have learned much more about the specific factors that can cause loneliness and isolation in later life. These factors can be physical (such as living with long term health problems or reduced mobility), emotional (such as mental health problems and feelings of vulnerability) and social (in terms of the lack of services for older people in some areas).

We have learnt that offering a person-centred CBT based approach works best and we’ve found that this needs to be flexible and tailored to the individual. It’s important to work in a holistic way and address the practical as well as psychological issues raised. Linking in with services and making referrals can be an essential part of addressing these barriers as they can contribute to a person’s mental health and wellbeing. 

As a client Lisa was very proactive in her own treatment and proved that cognitive behaviour therapy can be used successfully with older people. As she had various health issues it was important to be realistic when setting goals and so behaviour activation was somewhat restricted as her medical needs meant that she was unable to walk very far and was vulnerable to falls. Lisa also had lots of medical appointments and so a flexible approach had to be used when making appointments. Lisa was ready to make changes and wanted to help herself and this made a real difference to her outcome.

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