-   Effective Psychological Support
Dr Femke Leathes
Founder & Director
DClinPsych (University of Oxford)
Chartered Clinical Psychologist
Advanced Certified Schema Therapist

We offer psychological assessment and therapy to adults and young people suffering from a variety of psychological difficulties, including:

  • Obsessive Compulsive Disorder (OCD)
  • Depression
  • Panic Attacks
  • Stress
  • Phobias
  • Anxiety
  • Body Image, Eating & Weight Difficulties

Therapy is evidence based (primarily using Cognitive Behavioural Therapy (CBT)), and provided in a private, confidential and local setting in Caversham, North Reading.

Give us a call to have an informal chat, and/or to book an appointment.

Call 0118 9680898
What we can treat
Dr Femke Leathes DClinPsych

I am chartered by the British Psychological Society (BPS) and a registered member of the Health and Care Professions Council (HCPC).

My qualifications are:

- BA Hons (1st Class) Manchester University
- PsyDip (Distinction) Oxford Brookes University
- Doctorate in Clinical Psychology (D.Clin.Psych) Oxford University

I am an Advanced Certified Schema Therapist, and registered accordingly with the International Society of Schema Therapy

Following my undergraduate degree and before qualifying in clinical psychology, I worked for a number of years in business. This has given me a broader perspective on the challenges faced by many of my clients and their families.

I have experience working with a wide variety of clients and using different therapeutic approaches. My areas of special interest and experience, include anxiety, depression, eating disorders, difficulties with self-esteem and personality disorders. I specialise in working with clients with more longstanding difficulties.

I work predominantly using Schema Therapy and cognitive behavioural therapy (CBT), but do integrate other therapeutic models when required.

I have worked in the NHS for a number of years and continue to maintain links with the doctoral training course at Oxford University, for which I provide teaching.

Dr Jess Bezance DClinPsych

I am a registered member of the Health Professions Council (HCPC) and chartered by the British Psychological Society (BPS).

My qualifications are:

- BSc (Hons) Applied Psychology, Cardiff University
- Doctorate in Clinical Psychology (D.Clin.Psych), Oxford University
- Postgraduate Certificate in Intermediate Systemic Practice with Families and Couples, Bedfordshire University

I have experience working with a wide range of client difficulties across the lifespan. I am mindful of the importance of our context and relationships, and therefore adopt an integrated approach using ideas from cognitive behavioural therapy (CBT), compassion-focussed and systemic theory. My special areas of interest include low self-esteem, adjustment and transition and trauma.

Alongside my private work I work in the NHS with people with severe mental health difficulties. I also have links to Oxford University as a supervisor.

Dr Melissa Biggs D.Psych

I am a registered member of the Health and Care Professions Council (HCPC) and am chartered by the British Psychological Society (BPS).

My qualifications are:

- BSc (Hons) Durham University
- MSc Imperial College London
- PsyDip (Distinction) Middlesex University
- Doctorate in Counselling Psychology (D.Psych), London Metropolitan University

Prior to qualifying as a psychologist I worked for a number of years in business. This has provided me with experience and understanding of some of the issues faced by clients.

I am predominantly trained in the Cognitive Behavioural Therapy (CBT) approach, however I do offer an integrative service that is structured around client’s individual needs. I believe that a strong, trusting and collaborative therapeutic relationship can be the foundation for ongoing and life enhancing change.

I have experience of working with clients with a wide variety of difficulties using different therapeutic approaches. My areas of particular interest and experience include eating disorders, sexual health issues, anxiety, depression, grief, and difficulties with living with a chronic illness.

Dr Mark Bruce D.Psych.

I am a registered member of the Health and Care Professions Council (HCPC).

My qualifications are:

- BSc (Hons) Psychology, Loughborough University
- Diploma (Distinction) Psychoanalytic Theory
- Doctorate in Counselling Psychology (D. Psych), Glasgow Caledonian University

I have experience of working with clients with a wide variety of difficulties using different therapeutic approaches. My particular areas of interest and expertise include weight and eating-related conditions, depression, and post-traumatic stress disorder.

I am principally a CBT-oriented therapist, although I value the use of a range of approaches. We all experience our self, others and the world around us in a unique way and I will look to explore this with you within the context of a collaborative, caring and trusting therapeutic relationship. I work with adults, young people and groups and offer brief, as well as open-ended therapy.

Alongside private practice, I have experience working in a number of different environments including NHS hospitals, private hospitals, clinics, and charitable organisations. I currently work part-time for the NHS in a military veterans’ service, and part-time for a private hospital in a specialist weight management service.

Dr Jo Coombs D.Psych.

I am a Chartered Psychologist with the British Psychological Society (BPS) and a registered Practitioner Psychologist with the Health and Care Professions Council (HCPC).

My qualifications are:

- BSc (Hons) Psychology, University of Surrey
- PsychD Clinical Psychology, University of Surrey
- Graduate and Post-Graduate Certificates in Systemic Practice (Families and Couples), Institute of Family Therapy (IFT), Birkbeck College, University of London
- Integrative Restoration Level 1 Training, Integrative Restoration Institute (IRI)

Alongside my private work, I work in the NHS with people affected by neurodevelopmental conditions and have treated a highly varied cross-section of psychological presentations, including low mood, stress, depression, anxiety, self-esteem, self-image, bereavement and loss, relationship problems and adjustment to life events. I am able to work with individuals (adults), couples and families, including people affected by learning disabilities and their families.

I believe that meaningful change can be achieved in the context of a strong therapeutic relationship. I adopt an integrative approach which means that I will draw on a number of different psychological ideas and models in order to understand your difficulties and work jointly towards making meaningful change. These include Cognitive Behaviour Therapy (CBT), Attachment Narrative Therapy (ANT) and Acceptance and Commitment Therapy (ACT). I also have an interest and further training in a form of deep meditation called Integrative Restoration and Yoga Nidra which helps people to connect to their natural state of wellbeing. I believe it is very important to focus on strengths and positives alongside problems as people often have the skills and resilience’s to make helpful changes in their lives but perhaps have found it hard to hold these in mind when life is difficult.

I can offer clinical supervision as I am an Approved Supervisor on the BPS Register of Approved Psychology Practice Supervisors (RAPPS) and can also provide assessments of learning disability.

Dr Lisa Debrou PsychD

I am chartered by the British Psychological Society (BPS) and I am registered as a Practitioner Psychologist with the Health and Care Professions Council (HCPC).

My qualifications are:

- Bachelors degree in Psychology, University of the West of England
- Masters degree in Health Psychology, University of the West of England
- Doctorate in Clinical Psychology, University of Surrey

I work with adults and some older adolescents. I have worked with a variety of issues including obsessive compulsive disorder (OCD), phobias, anxiety, depression, panic, PTSD, adjustment issues (to health conditions), relationship problems, low self-esteem, burnout and work-related stress. The main therapy models I use in my work are Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT). My areas of special interest are with people who are living with chronic health conditions or life-limiting illnesses, medically-related phobias and general adult mental health. I have experience of working both in the NHS and the private sector (both in the UK and abroad).

My approach when working with someone is always to try first to understand their story. I genuinely enjoy working with people to try and find a way through their difficulties. Being ‘stuck’ in distress can often feel overwhelming and it is hard to know how to find a way out. I see my role as a psychologist in therapy as being a guide to help people become ‘unstuck’ so quality of life can improve. I will always tailor what I am doing to the person in front of me.

Dr Alison Griffiths DClinPsy

I am an HCPC-registered practitioner psychologist and a BPS (British Psychological Society) chartered psychologist. I also have full accreditation with the BABCP (British Association of Behavioural and Cognitive Psychotherapists).

My qualifications are:

- BSc Hons Psychology, University of Nottingham
- Doctorate in Clinical Psychology (D.Clin.Psych), University College London

I have worked in a range of NHS psychology services throughout my career, both as a clinician and in leadership roles. I currently work part time in an NHS Clinical Health Psychology service, in addition to independently running mindfulness courses and workshops.

My central model of treatment is CBT (Cognitive Behavioural Therapy). However, I have also trained in IPT (Interpersonal Psychotherapy), MBCT (Mindfulness Based Cognitive Therapy) and ACT (Acceptance and Commitment Therapy). I tend to integrate key ideas from each of these approaches into my therapeutic practice.

I specialise in the treatment of difficulties such as Depression, Obsessive Compulsive Disorder (OCD), Generalized Anxiety Disorder and Health Anxiety. I also have a strong interest in working with people with physical health conditions to facilitate psychological adjustment to any associated life changes. My other interest is in working with people to overcome weight problems, particularly overweight and obesity.

I use treatment approaches approved by NICE (National Institute for Health and Care Excellence) or otherwise supported by a body of scientific research. Alongside this, I recognise each individual’s unique life circumstances and their influence on the development of their difficulties. I take a compassionate, collaborative and solution-focused approach, supporting clients to build on their existing strengths, as well as to learn new skills. I aim for clients to overcome current challenges and build future resilience, so as to lead a more valued life.

Julia Kelly MSc (Merit), CPsychol

I am chartered by the British Psychological Society (BPS) and am a registered member of the Health and Care Professions Council (HCPC).

My qualifications are:

- BSc (Hons) Psychology, The Open University
- MSc (Merit) Criminological Psychology, University of Birmingham
- Qualification in Forensic Psychology (Stage 2), The British Psychological Society
- PG Cert Cognitive Therapy for Severe Mental Health Problems, University of Southampton

I have post-graduate training in cognitive behavioural therapy (CBT), and am a fully accredited Cognitive Behavioural Psychotherapist with the British Association of Behavioural and Cognitive Psychotherapists (BABCP). I predominantly use Cognitive Behavioural Therapy in my clinical practice but will also draw on a variety of other approaches where appropriate, including Mentalisation-based and Systemic approaches in which I have had further training and supervision. 

I have worked for the NHS since 2005 across a range of in-patient and community settings and currently work as a specialist psychologist in a service for adults with complex needs and personality disorders. I have also lectured for The Open University on the BA/BSc (Hons) Psychology curriculum since 2009.

My areas of special interest and experience are working with adults with personality difficulties, anxiety, depression, addiction and problematic anger. I also have experience of working with people with mild learning disabilities.

My aim is to work collaboratively with people in order to facilitate a greater understanding of their psychological difficulties and to support them to work towards desired change.

Dr Karla Maguire PsychD

I am a Chartered Psychologist with the British Psychological Society (BPS) and a registered Practitioner Psychologist with the Health and Care Professions Council (HCPC).

My qualifications are:

- BSc (Hons) Psychology, Physical and Mental Health, University of Reading
- Postgrad. Cert in Evidence Based Psychological Therapies, University of Reading
- Doctorate in Clinical Psychology. PsychD. University of Surrey

I have experience of working with adults and young people supporting them with a range of difficulties including depression, anxiety, stress, low self-esteem, relationships, loss and adjustment.

I aim to work with clients to develop a helpful understanding of their difficulties from which we can identify ways to work towards improving their emotional wellbeing. I believe in the importance of a safe, honest therapeutic relationship that supports clients to share their difficulties and make the changes that are important to them.

My main therapy model is Cognitive Behavioural Therapy (CBT) however I draw on other approaches depending on each client’s individual needs and goals. These include Acceptance and Commitment Therapy (ACT), Compassion Focussed Therapy (CFT) and systemic approaches.

Alongside my private practice, I work in the NHS with people with learning disabilities. I have links to several universities as a supervisor and mentor for students on doctoral training courses.

Dr Hayley Marwood DClinPsych

I am a registered member of the Health and Care Professions Council (HCPC) and a member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP).

My qualifications are:

- Doctorate in Clinical Psychology (D.Clin.Psych), University of East London
- Postgrad. Diploma in Evidence Based Psychological Therapies, University of Reading
- BA (Hons), University of West England

I have worked clinically in the NHS for a number of years and I have a range of experience working with clients across the lifespan, particularly with adults and adolescents, in various treatment settings. My areas of special interest and experience include anxiety disorders, post-traumatic stress disorder (PTSD) and depression. I work mainly using cognitive behavioural therapy, although draw on other approaches, such as compassionate-focused approaches, in order to meet my client’s needs.

Alongside working in private practice, I currently work as a specialist clinical psychologist in the NHS with adults experiencing PTSD and complex needs. I also work as a clinical tutor, providing teaching and clinical supervision to trainee cognitive behavioural therapists at the University of Reading.

Dr Phil Moss Psych.D., AFBPsS

I am chartered by, and am an Associate Fellow of, the British Psychological Society (BPS) and a registered member of the Health and Care Professions Council (HCPC).

My qualifications are:

- BSc (Hons) Psychology, University of Plymouth
- M.Sc. Clinical Psychology, University of Surrey
- Doctorate in Clinical Psychology (Psych. D.), University of Surrey

I have further post-doctoral training in other therapeutic approaches including Dialectical Behaviour Training (DBT), Acceptance and Commitment Therapy (ACT) and Cognitive Analytical Therapy (CAT), and in working with addictions and personality disorders.

My main approach is Cognitive Behavioural Therapy (CBT), although I use other approaches such as DBT, mindfulness-based approaches, CAT and compassionate-focused approaches as required. My aim is to help people to achieve the best possible resolution and recovery from the difficulties they are experiencing.

I have considerable experience as a Consultant Clinical Psychologist in adult mental health, pain management, disability work, and in forensic mental health. In addition to working in private practice, I currently work in the NHS with ex-armed services veterans with mental health and adjustment difficulties.

Dr Nicola Smith DClinPsych

I am a registered member of the Health and Care Professions Council (HCPC) and am chartered by the British Psychological Society (BPS).

My qualifications are:

- BSc (Hons) Psychology, University of Hertfordshire
- Doctorate in Clinical and Community Psychology, University of Exeter

I have experience working with individuals with a variety of difficulties using a range of approaches as best suits the client and their individual needs. I am particularly interested in working from a CBT perspective, and also draw on ACT (Acceptance and Commitment Therapy) and Mindfulness. I enjoy working with couples and families from both a systemic and CBT approach. 

I have worked in a variety of settings. Initially I worked for the NHS in a range of services for people with mental and physical health problems. I have also worked in a number of schools and charitable sector services supporting children, young people and families with emotional and behavioural difficulties. More recently, alongside private work, I have worked as Psychology Lead for a public health commissioned service in Oxfordshire. In addition to my clinical work I provide oversight to a community counselling service in Cambridgeshire and am a university lecturer in counselling and psychotherapy.

Dr Melissa Snaith MA(Hons), DClinPsych

I am a registered member of the Health and Care Professions Council (HCPC) and a member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP).

My qualifications are:

- Doctorate in Clinical Psychology (D.Clin.Psych) Oxford University
- Postgrad. Certificate in Advanced Trauma Studies
- Postgrad. Diploma in Evidence Based Psychological Therapies, Reading University
- BA (Hons) Reading University

I use a number of different therapeutic approaches, so I can adapt treatment to suit clients’ individual needs. I have further post-doctoral training in cognitive behavioural therapy (CBT), Schema Therapy and Emotion Focused Therapy.

I work with a wide variety of clients, primarily adults and adolescents. My areas of special interest and experience include post-traumatic stress disorder (PTSD), anxiety and stress, depression, obsessive compulsive disorder (OCD) and difficulties with self-esteem.

Prior to qualifying in clinical psychology, I worked for a number of years in management, commissioning and strategy roles. I have worked clinically in the NHS for a number of years and currently work as a specialist psychologist in a service for post-traumatic stress disorder. I’m also a clinical tutor at Reading University lecturing and supervising trainee cognitive behavioural therapists.

Dr Sian Thomas DClinPsych

I am a Clinical Psychologist, specialising in working with children, young people and families. I am a registered member of the Health and Care Professions Council (HCPC) and chartered by the British Psychological Society (BPS).

My qualifications are:

- Doctorate in Clinical Psychology (DClinPsych), University of East London
- MSc in Health Psychology, University of Westminster
- BSc (Hons) Psychology with Sociology, University of Bath

My approach is integrative, recognising the importance of context and relationships, working collaboratively with each individual and their family with an aim of achieving meaningful change. I am able to use a range of therapeutic approaches in my work, including Cognitive Behavioural Therapy (CBT), Systemic Therapy and Acceptance and Commitment Therapy (ACT). I have experience of working with a range of difficulties across the lifespan. My areas of interest include physical health, anxiety, self-esteem, behaviour, development, body image, appearance and visible difference.

I have worked in an NHS Child and Adolescent Mental Health Service (CAMHS) in Central London, which included working in schools, children’s centres, GP practices and a Social Care Fostering team. Between 2011 and 2018 I worked at the John Radcliffe Hospital in Oxford supporting children and families attending specialist surgery services. I now work solely in private practice.

Why choose a private psychologist?

There are several different types of therapists offering psychological help in varying ways. Some will be more suited to certain people and particular types of difficulties than others.

Whichever type of therapist you choose to see, it is important you ensure they are approved and registered with an appropriate professional body.

Evidence Based Therapy

Clinical and counselling psychologists are trained to use evidence-based psychological methods of assessment and treatment.

As such, they use therapeutic approaches that are often cited in the guidelines of the National Institute of Clinical Excellence (NICE) as recommended treatments.

Quality Training

Clinical and counselling psychologists have an undergraduate degree in psychology, or combined honours or conversion diploma (all must be accredited by the British Psychological Society), followed by a three year postgraduate Doctorate.

Doctoral training comprises several intensive placements in different specialities, many of which are within the NHS, ensuring a wide breadth of experience as well as more specialist training closer to qualification.

More flexibility

While the services of psychologists are offered by many NHS Trusts, there is a recognised shortage. If you are seeking assessment and/or treatment you should contact your GP in the first instance. He/she should be able to let you know what services are available locally, and how long any waiting lists may be.

Following such enquiries, and in some instances following initial treatment, some people decide to self-refer to a private clinical psychologist who may be able to see them sooner, offer different treatments and/or offer more sessions than might be available with the NHS.

Your therapy
Initial Assessment

All therapy starts with a detailed assessment of the difficulty in the context of the person’s life and wider circumstances. We will ask you various questions and may also ask you to complete one or more standardised questionnaires.

Assessment usually takes between one and two sessions. At the end of the assessment session(s), having established your needs and goals, we will draw up a formulation of the difficulty and discuss whether therapy would be helpful.

We'll then explore options for treatment with you and give you an idea of how long it is likely to last.


Most of us work using a primarily cognitive behavioural (CBT) based approach, although we also use, and integrate, other forms of treatment when pertinent. Several of us work using schema therapy, acceptance and commitment therapy (ACT) and cognitive analytic therapy (CAT), among other approaches.

Therapy sessions occur on a weekly basis where possible and last for 50 minutes. I will guide the treatment and format of the sessions, asking questions, presenting ideas and psychological knowledge. We will also introduce exploratory exercises, and encourage you to continue these outside of sessions.

Progress towards the goals of therapy is monitored continually and openly shared. The ultimate aim is for you to become the expert at understanding and managing your own difficulties, both now and for the future.

Leaving Therapy

Our psychologists adhere to a strict Code of Ethics as outlined by the British Psychological Society. We therefore aim to offer as few sessions as necessary in order for you to reach your treatment goals.

The decision of when and how to end therapy, however, will always be taken jointly with you. We will of course take your funding circumstances into account.

A formal ending session will be arranged, during which you will receive a closing folder containing relevant documents and diagrams from your time in therapy. The folder will also include a therapy blueprint, which acts as a summary of the therapeutic process that can be referred to later on.

A little about Cognitive Behavioural Therapy (CBT)
Unhelpful behaviours

What we think influences how we feel, and subsequently how we behave or act. This is the case for all of us, all of the time. When someone is suffering from a psychological difficulty, some of their thoughts lead to unpleasant/unwanted feelings, and often unhelpful behaviours. The unhelpful behaviours (e.g. social withdrawal, avoidance, extreme checking etc.) often serve to encourage further negative or worrying thoughts, and people become locked in a vicious circle.

Understanding unhelpful circles
CBT works by helping people understand their own unhelpful circles (between thoughts, feelings and behaviours), and by supporting them to try out new approaches. It is not about ‘rewriting your thoughts’ as people sometimes fear. Rather it focuses on helping you to think in a more balanced way, improving the way you feel, and changing any unhelpful patterns of behaving. People move from being stuck in a vicious circle to living in a positive cycle of thinking, feeling and behaving. It is an empowering therapy, giving you, the client, the skills to take charge of your own psychological wellbeing.
A treatment of choice
CBT is a scientific approach and is the evidenced-based treatment of choice for a number of mental health difficulties. It is recommended by The National Institute of Clinical Excellent (NICE) for many conditions. Our practice is largely based on CBT. We do supplement CBT with other therapeutic approaches where this would be helpful for individual clients.

Fees for therapy

We help people who are self-funding, or using private medical insurance. We are a registered provider of psychological services with major private healthcare companies.

Our fees for clients aged 16 and above are £95, for both assessment and treatment sessions (all of which are 50 minutes in duration).

Fees for child and adolescent clients aged below 16 are £240 for assessments (90 minutes) and £120 for follow-up treatment sessions (50 minutes).

Fees for training, teaching or group therapy are also available on request.

Client success stories
Aged: 33
IT Consultant

Mark worked locally as an IT consultant and enjoyed spending time with his wife Amy and their two young children. For several months Mark had noticed his desire to have a clean house, and to be clean himself, had got out of hand. He would wash his hands up to 120 times a day, and was unable to go to bed at night unless all the rooms in the house had been vacuumed, the loos had been bleached and all the door handles had been disinfected. One evening, Amy noticed Mark cleaning each item in their daughter’s dolls’ house with a Detol wipe, and she broke down. Mark told me it was the conversation he had with Amy that night that made him realise he needed help.

Mark had a total of ten sessions with me, the first of which was a detailed assessment. At the end of the assessment, Mark and I drew out a formulation diagram which explained how Mark’s thoughts about cleanliness for his family were causing him intense anxiety, leading to the cleaning behaviours (or ‘compulsions’) he described. Mark realised that by performing all his cleaning tasks, although he felt reassured in the short term, they prevented him from trusting that no harm would come to anyone in his family if he returned to the way he and Amy used to keep their house clean before OCD took over.

Mark embarked on nine sessions of CBT for OCD during which he learnt about OCD and how it manifested in him. We used this understanding to work through a series of behavioural experiments during which Mark was supported to reduce his cleaning activities while he was at home in between his sessions. Mark learnt how to manage the anxiety he experienced at these times, and developed the skills to challenge the obsessive thoughts about cleanliness and germs in a different way. By the end of the therapy Mark felt he had reached his goal of ‘not worrying any more about cleaning and germs than my brother does’. He took away a blueprint of the sessions which summarised the skills he had learnt. Mark thought this would be useful to refer to in the months to come.

Aged: 56
Low self-esteem

Pamela worked in a catering business she had started 10 years ago with a friend. She had two children, both of whom had now left home. Her husband, Paul, worked in a senior position at a technology firm. As Pamela put it, ‘on paper’ it appeared she was a successful business woman with a thriving family, but she felt deep down that she wasn’t ‘good enough’. She described being worried constantly that she was going to fail, which she said made her feel stressed and miserable.

I met with Pamela for 1 assessment session, after which we agreed to embark on a course of Cognitive Behaviour Therapy (CBT) for low self-esteem. By the end of the assessment, the information I had learnt from Pamela had enabled me to draw out a diagram representing a vicious circle of thoughts, feelings and actions we both agreed Pamela was stuck in. We focused also, and particuarly in Pamela’s case, on a series of ‘life rules’ she seemed to have developed which were making things very difficult for her. For example, it seemed that Pamela had, almost unconsciously, tried to compensate for her thoughts about being ‘not good enough’ by making sure she worked harder than anyone else, both at her business and at her personal relationships. There was the implication for Pamela that ‘if I try harder to be perfect than other people, then I might be able to make up for being not good enough’. This ‘rule’, however, actually caused Pamela no end of problems. It is actually impossible to be perfect, and certainly not in several areas of your life at the same time. Pamela would, for example, work late into the night trying to get the plans for a forthcoming event she was catering for right. This made her very tired, and as a result paradoxically more likely to make mistakes. It also meant Pamela was exhausted the next day, and more likely to snap at her husband. When Pamela did make a mistake, or when she did lose her temper, she became very angry with herself for being so ‘useless’, which brought all her thoughts about being ‘not good enough’ back up to the surface. Pamela would respond by resolving to ‘work harder’ the next day, and so the vicious circle continued.

Pamela found the assessment itself very enlightening. She told me she had not realised she was, in her words, ‘my own worst enemy’. She felt relieved because she could see that there was something she might actually be able to do to change how she felt, although she did admit to being apprehensive about whether or not she would be able to change.

I saw Pamela for a total of 9 sessions. Following some more exploration around the difficulty, we began by encouraging Pamela to start ‘breaking’ her life rules in order that she might be able to let them go, or at least to make them less extreme. Pamela understandably found this difficult at first, after all the ‘rules’ had been developed for a good reason; they protected her from having to feel that she wasn’t good enough. Pamela was frightened that she would fail if she wasn’t trying to be perfect, so we set up a series of ‘experiments’ she could try in between sessions to help build her confidence. The experiments started off gently, and became more challenging once Pamela’s confidence began to grow. One example was that Pamela worked on saying ‘no’ to members of her family more effectively. Previously she would spend hours on the telephone to her children helping them with various ups and downs. She would take calls at any time of day, meaning other aspects of her life and business would suffer, and for as long as her children wanted to talk, sometimes for hours taking up entire evenings. Pamela was very reluctant to manage these calls differently because she worried that doing so would make her a ‘bad mother’. The first time she experimented in this area, she told her daughter, who rang in the middle of one of Pamela’s planning sessions with her business partner, that she would have to call her back in an hour but that she would only have 30 minutes to chat because she had a hair appointment. Not only was Pamela’s daughter accepting of this, they had a helpful, more focused, conversation when Pamela rang back, after which her daughter thanked her for supporting her to make a decision. Pamela was extremely surprised at this outcome. However, it, and the results of the many other experiments we designed, began to genuinely improve her confidence. By the end of therapy Pamela told me she had realised that she couldn’t have been the failure she used to believe she was because, once she became more relaxed about how she lived her life, things began to work more not less successfully. With her ‘rules’ less extreme, Pamela also felt less stressed and more in control of all the things she had to juggle. Like other clients, she took away a blueprint of the therapy to refer to in future. Pamela told me she had stuck the now positive, rather than vicious, circle we drew out in the inside flap of her diary in order to remind her how much things had changed for the better.

Note: I did not spend time with Pamela discussing her earlier life experiences in any detail because, although relevant, doing so was not necessary in her case in order to bring about the positive changes Pamela wanted to achieve. However, work on early life experiences can often be very helpful, if not necessary, in some cases of low self-esteem. Where this is the case, I will discuss with you as the client the benefits of including such work in therapy.

Aged: 16

Alex had just had his 16th birthday when he and his parents came to see me for assessment. Alex’ parents rightly felt that Alex would benefit from some Cognitive Behaviour Therapy (CBT), and did not want him to be on a waiting list, particularly as they knew he was in the middle of his final year of GCSEs. Antidepressant medication is not recommended as a first line of treatment for young people unless taken concurrently with psychological therapy (National Institute for Health and Clinical Excellence, 2005).

I spoke with Alex and his parents, both together and separately, over an extended 90-minute assessment session. Alex had no history of low mood. He was a popular boy, with a good network of friends. He did well enough at school and enjoyed playing sport. Alex was a member of a local tennis club and played in a football league with a junior team. Alex’ parents wondered whether the low mood had started following a broken leg he sustained the previous term, which prevented him from playing sport for several months. Alex agreed with this idea, but he added that he also felt very worried about his future. He was anxious about his upcoming GCSEs and said that, unlike his peers at school, he had no idea what he wanted to do in terms of a career. I learnt also that Alex’ grandfather, with whom he was very close, had died the previous Christmas.

At the end of the assessment I drew a diagram detailing the last year or so of Alex’ life. The death of his grandfather had come as a shock to Alex and he had found himself trying to deal with a lot of difficult questions, such as what the purpose of one’s life should be. Not too long after the family suffered this loss, Alex broke his leg playing football. He spent several months recovering, during which time he was not spending his weekends playing sport or seeing his sport-related friends. Alex became increasingly withdrawn. It was, as Alex put it later on, a ‘double whammy’: he lost the sense of purpose and self-esteem that he now realised he gained from his sport, but also had a lot of time on his hands to ruminate difficult life questions. The diagram showed how Alex had now become stuck in a vicious circle of negative thoughts, which made him feel low, despondent and unmotivated, leading to a change in his typical behaviours: Alex no longer went out, he stopped focusing on school work, and he distanced himself from his friends. This new way of acting naturally did not help Alex to think more positively about anything, and so the vicious circle continued.

Alex said he felt like he was understood, and that the diagram helped him to make sense of what he described as the ‘mess in my head’. Alex’ parents found the assessment helpful because they had been able to have a frank discussion with their son, and learn about his perspective instead of hypothesising themselves and feeling powerless to help him. We agreed to start a course of Cognitive Behaviour Therapy (CBT) to reverse this vicious circle. I saw Alex for a total of 12 sessions, initially on a weekly basis, but then fortnightly as he felt he was making such good progress.

Some of the elements of the therapy included:

  • Helping Alex learn to identify his thoughts and his feelings, so he could gain control over them rather than feeling like his head was ‘a mess’;
  • Spending time discussing Alex’ grandfather’s death to help him move forward (Alex found it easier to talk about this to me because he was not worried about upsetting me, unlike other members of his family);
  • Activity scheduling to encourage Alex to change some of the new behaviours he had developed (i.e. going out more, getting back into sport, scheduling short periods of time into his week for academic work so it felt manageable, not overwhelming);
  • Working with Alex to develop strategies that worked for him to think in a more balanced way;
  • Teaching Alex ways of tolerating distress and ‘getting through’ difficult days, without having to resort to doing something that made things worse;
  • Talking with Alex about his future and helping him develop a balanced approach, putting less pressure on himself to make decisions he did not actually need to make at this point in his life.

All our appointments were conducted with just Alex and myself. However, at the end of many of the sessions, Alex and I would decide to invite either one or both of his parents (depending on who had accompanied him to the clinic) in for the last 10 minutes. We agreed what we would share and why it might be helpful to do so. Alex admitted he was nervous about doing this initially, but after a few weeks he told me that he felt it made a big difference to his parents’ level of understanding. This in turn made it easier for him to be at home and to ask for back up from his parents if he needed it. Alex’ parents were very pleased to be involved as it meant they could do something to help him, and, as Alex’ mother put it one day ‘at least I don’t put my foot in it anymore’! The whole family reported they felt closer to one another and were able, finally, to regain a shared sense of humour.

By the end of the therapy, Alex had returned to playing football although he had decided to stop tennis for the time being so he had fewer pressures placed on his time. He found it much easier to strike a balance between study and other aspects of his now growing social life, and less worried about his future. Alex told me he felt ‘like myself’ again. Although he admitted there were times (e.g. when something went wrong at school) when he noticed negative thoughts arising, Alex now felt able to stop any ensuing vicious circles in their tracks. He took away a blueprint of all the work we had covered together which he said he might refer to at these times in order to get an ‘extra boost’. Alex said he felt in control of his life and looked forward to a positive, if not totally defined future.

Aged: 23
Eating difficulties

Laura had recently returned home from a 3-year economics degree at university. She lived with her parents and was a graduate trainee with a leading firm of accountants. Laura had suffered from anorexia nervosa for two years between the ages of 15-17. She received treatment and recovered to the extent her weight returned to within the normal range. Laura was an intelligent young woman with a strong academic record. She had pursued a demanding degree at a prestigious university, but spent her three years there doing little other than work. She admitted that, by focusing on her work, she had managed to ignore other underlying worries about her weight, appearance and the way she was viewed by her peers. Having returned home, Laura felt some of her old anxieties resurfacing. She described an increasing sense of insecurity about her future and her relationships with others, an urge to return to restricted eating, and a general sense of low self-esteem.

Laura came to see me for two assessment sessions, during which we discovered the feelings she described had been with her for many years. I hypothesised with Laura that the original underlying reasons for the eating disorder as a teenager were very much unresolved. Laura agreed she did not know why she felt the way she did, and that her original treatment had focused mainly on weight gain. She had been discharged very shortly after restoring her weight. Laura felt stuck in negative patterns of thinking and feeling which did not seem to change despite her knowing some psychological techniques to improve them. We agreed to pursue a course of schema therapy, a type of cognitive therapy, which is more holistic in its approach.

Therapy began with exploring Laura’s earlier life, identifying the self-defeating patterns she had developed over the years. Highlighting these and identifying the reasons they arose gave Laura a huge sense of relief. She explained she no longer felt ‘wrong’ or ‘bad’ for feeling the way she did, and since she could now see the reasons for her feelings and thoughts, she felt excited and able to explore the process of change. Laura and I continued the therapy, supporting her to make real changes in her life, trying out new patterns and waiting to see the results. For example, she began to act ‘as though’ her deep seated beliefs about being unlikable were false (even though deep down she believed them to be true). Instead of shunning social situations, she began to accept invitations, starting initially in a small way, by going out for a drink with colleagues after work. Laura was amazed to see that people did appear to value her company, a realisation that boosted her confidence and slowly began to change the way she felt about herself. We maintained a second focus in each session on Laura’s thoughts and feelings towards her body and eating, until gradually these became interwoven with the schema work. With the other improvements in her life, her feelings and her thoughts, Laura began to worry much less about how she looked, and certainly about how much she weighed or what she ate.

I saw Laura for a total of 21 sessions, although later sessions were spaced out with long gaps, given Laura had made so much progress in her life at that point. The final few sessions were designed merely to confirm to Laura that she could trust in her sense that things had really changed. They also focused on summarising the schema therapy and preparing Laura for an exciting future using all the skills and knowledge she had gained to maintain the positive changes for years to come.

*Please note that to preserve client confidentiality, the client stories are all compiled from a number of different clients, and different names have been used to preserve anonymity. Any resemblance to actual people is purely coincidental and fictitious.
Frequently asked questions
Will anyone need to know I'm coming to see you?

The service offered is entirely confidential. It is against the ethical code of conduct to discuss clients or their details in any way with any other person. There are two exceptions:

- Professional Supervision: We have regular supervision with another clinical psychologist as required in our code of conduct. We will discuss clients in these sessions in order for the supervisor to support the therapy offered and so ensure clients are receiving the best possible care. All supervision discussions are, however, anonymous.

- Risk: should any clients disclose information to us that indicates either they or another person are at risk of serious harm, we have a duty to disclose this information to a pertinent third party (e.g. GP, Social Services, next of kin if under age 16 etc.). We will never make any such disclosures however without informing the client in the first instance.

Note: If you have been referred to us in writing by another healthcare professional, it is standard practice to send that professional an assessment report following your first assessment with us, with a copy to you and to your GP. If you do not wish us to do so, you can discuss this with your psychologist when you come for assessment.

I would like my GP to be informed of my treatment, how can he/she be kept informed?

Good practice would normally involve your GP, although this is not essential if you are self-referring. Your GP can be involved by receiving two reports: one after assessment outlining the proposed treatment, and a second on completion of therapy so he/she knows the treatment you have received and the outcome(s). You will receive copies of any reports written. Assessment and ending reports are part of the standard practice and are provided at no extra fee, however they are not compulsory.

Should I bring anything with me when I come for the assessment?

You do not need to bring anything with you. Some clients like to bring personal notes or diaries with them to act as aide memoirs but this is an exception rather than a rule and is by no means necessary.

If I am a parent of a young person (under the age of 16) who is coming for therapy, will I know what’s happening and how they’re getting on?

The content of all sessions with any client (regardless of their age) is confidential. However, as the parent of a young person it is usually important that you are involved to a greater or lesser extent in your child’s treatment. Parents often have a prominent role to play in their child’s recovery. While every family is different, we usually suggest that one or both parents accompany the young person to the assessment appointment and be present for as much of it as they and/or their child feels comfortable. We also aim to meet with the young person and the parent(s) on their own at this stage. Once therapy begins, it is usual for a parent to join the final 10 minutes of each session for feedback (the content of which is agreed with the young person beforehand so as not to breach the confidentiality of the session). Young people under the age of 16 require an adult chaperone (usually a parent) for the duration of each session who may wait in the comfortable waiting room.

How do I go about cancelling an appointment?

Appointments cancelled by phone or email more than two working days beforehand are not charged. Cancellations with less than 2 working days’ notice, or non attendance, will be charged at the full rate because it is then difficult to offer the appointment to another client.

I’m having a particularly difficult week and could do with more support. What can I do?

We do offer additional sessions when there is a particular necessity and if there is availability. Please telephone so we can decide together whether an additional session would be helpful. It may be that we refer you to some of the material we have covered in our sessions rather than come in for an extra session. Telephone calls of this nature lasting more than 10 minutes will be charged at the telephone session rate. We will respond to any calls made during working hours (Monday-Friday 9am - 5pm). If you are calling outside of these times, you will be able to leave a message, but we will not receive it until the following working morning.

What if if turns out I need help from elsewhere?

When you first telephone me to make an enquiry, we will take brief details from you about the difficulty you are experiencing before making a face-to-face assessment appointment. We will refer you elsewhere during this initial conversation if we think your needs would be better met by a different service. Clients offered an assessment appointment are usually suffering from difficulties suited to the treatments we offer. Should this turn out not to be the case, or should, during the course of therapy, particular difficulties come to light that warrant external help, we will support you to make appropriate onward referrals in the local area.