Therapy Models

Acceptance & Commitment Therapy (ACT)

As human beings we all experience difficult thoughts, feelings and unwanted physical sensations, sometimes in connection with past and/or ongoing life events. We naturally seek to cope with these internal experiences by trying to eliminate them. Common coping strategies can include physical avoidance, distraction and mental analysis, to name but a few.

Schema Informed Approach

Although what we think can influence how we feel, sometimes our feelings come from a different place entirely; from patterns of feeling that we have ‘learnt’ (often unconsciously) from earlier life experiences. Trying to soothe our feelings through rational argument therefore doesn’t work too well. Sometimes we may even have tried therapy before and become disheartened that it hasn’t ‘worked’ or, worse still, been left feeling we are beyond help or even ‘crazy’.

Schema therapy, and related schema-informed approaches, works directly with the feelings themselves (rather than trying to access them solely through our rational thoughts and discussions). It is often described as working on a deeper level than therapies like CBT, getting down to the core of who we are, our personalities, our tendencies and the experiences that have shaped how we respond emotionally to the world around us.

Experiencing emotions and change safely

Schema work relies heavily on a strong therapeutic bond between therapist and client. This grows over time and serves as a safe place; a connection and form of support that may previously have been partly or completely unavailable. From this secure base we work collaboratively with our therapist to build understanding and to work directly, in an experiential way, with our ‘live’ emotions during the sessions. Techniques such as imagery and chair work help bring the real core of what we are feeling to life. We identify our less-than-helpful internal modes (such as our inner critic) and learn how to strengthen a more ‘healthy adult’ response to getting our emotional needs met.

A balance

Schema therapy is an evidenced-based approach that developed by integrating cognitive (e.g. CBT) and psychodynamic ways of working. It tends to suit those of us with longer-term struggles that have been on and off for some time and more resistant to change with short-term approaches.

Useful links:

International Society for Schema Therapy (ISST) - Visit website

Schema Therapy Institute - Visit website

Cognitive Analytical Therapy (CAT)

Cognitive Analytic Therapy (CAT) looks more deeply at how our past experiences have impacted our lives and our relationships in the present. It draws on elements of cognitive therapies, like CBT, as well as psychoanalytic therapies (these focus on the way that we relate to others, such as family, friends, colleagues, - and how others relate to us). CAT also helps us to better understand our relationship with ourselves.

Looking more deeply

CAT can help us recognise patterns of thinking, feeling, and behaving that might be getting in the way of us making the most of our lives and relationships. Typically, these patterns are learnt early on in life as ways of surviving, coping, receiving love or avoiding pain. For example, if we have experienced rejection in our early life we might find ourselves very sensitive to rejection in our relationships as an adult. We might also notice that we tend to be reject others and ourselves. We might even seem to attract or be drawn to people who will go on to reject us.

Working together

CAT is a collaborative type of therapy - the therapist doesn’t tell the client what to do but will actively work together with them to help them gain insight and make changes that could enhance their life. Therapists are up front and open. After several sessions the therapist may write a letter which summarises what has been talked about so far and identifies a suggested focus for the rest of the therapy. The therapist might also invite the client to help them map out their relationship patterns on paper as a way of enabling the client to better recognise them in their daily life. CAT is a time limited therapy. Clients will usually begin with 6 sessions, then review how things are going before agreeing with the therapist how many more sessions will be needed. Typically, CAT therapy lasts for a total of 16 or 24 sessions but this can be tailored to individual requirements.

CAT is an integrative type of therapy so therapists may draw on or include other therapies or methods (such as mindfulness for example) if they think it will be useful. CAT is an evidence-based therapy that seeks to address the underlying reasons that brought a client to therapy rather than focus on a diagnosis or label. Issues that are often worked on in CAT include anxiety, depression, relationship issues, trauma, stress, and self-harm.

Useful link:

Associate of Cognitive Analytic Therapy (ACAT) - Visit website

Cognitive Behavioural Therapy (CBT)

What we think influences how we feel, and subsequently how we behave or act. 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.

Compassion Focused Therapy (CFT)

We all have an internal system that regulates our emotions. This system has default settings that we think we are all born with. Some of the settings help us process emotions based on principles of reassurance and safety, whilst others are more ‘threat-based’. Depending to some extent on how those around us responded to us and our feelings, we ‘learnt’ (although often unconsciously) that some of our default settings were more applicable to our personal set of circumstances than others.

Shame and Self-criticism

Some of us, for example, learnt to rely more on the ‘threat-based’ system which focuses more on shame, self-blame and self-criticism. People who have this threat-based default, tend to sense they are no good and that what they feel is ‘wrong’ or ‘too much’.

Building a new skill

The ability to treat ourselves with compassion is key to being able to access and explore difficult emotions (instead of trying to get rid of them, pretend they are not there, or distract ourselves from them). It enables us to engage with more helpful ways of managing difficult feelings, for example by seeking support from others, taking care of ourselves and so on.

CFT helps clients to build or strengthen the part of their emotional regulation system that evolved to help humans reach a state of 'safeness’. This includes fostering a stronger sense of compassion for self and others so that this stance dominates over shame and self-criticism (and not the other way round). With that in place, clients practice a new way to relate to themselves and their emotions, often then making different choices about how they run their lives.

A integrative, research-based approach

CFT is a scientific approach that marries modern neuroscience with more traditional, long-standing psychological models such as attachment theory. Evidence behind the approach continues to build – even showing compelling links between self-compassion and physical health and immune responses.

Useful links

The Compassionate Mind Foundation - Visit website

The charity Anxiety UK - Visit website

Eye Movement Desensitisation and Reprocessing Therapy (EMDR)

Eye Movement Desensitisation & Reprocessing Therapy (EMDR)

When we talk about an experience being ‘traumatic’ it means that it was in some way distressing, overwhelming, or exceeded our ability to cope. PTSD can occur when something highly traumatic happens to a person such as a serious accident or an assault. Our nervous systems respond to hormones like adrenaline with a ‘fight, flight, freeze, or flop’ reaction.

PTSD and Trauma

In theory, once we are out of danger, the sensory cues from being safe again should ‘reassure’ our nervous system that the danger has passed, and our body’s high alert status returns to normal. However, for many people, and for a variety of reasons, this process becomes disrupted and the trauma gets ‘stuck’ in the body. This means that the body keeps going into high alert mode when it doesn’t need to. People can experience symptoms of PTSD such as flashbacks, nightmares, a racing heart or jumpiness, accompanied by intense feelings such as anger or fear.

It is also the case that the accumulation of smaller, non-life-threatening events over a period of time can be traumatic. Things like divorce, bullying and emotional abuse in our adult lives have the potential to be experienced as traumatic - as do events from our childhood. In these cases we might not experience any of the symptoms of PTSD listed above, but instead can tend to react to certain things disproportionately, or struggle with particular relationships or in certain areas of our lives.

What is EMDR?

EMDR is a therapy designed to help get the trauma ‘unstuck’. It reprocesses the memory so that it no longer causes as much emotional disturbance. The memory becomes ‘an upsetting memory’ rather than something capable of triggering strong psychological distress, or of making our bodies suddenly go into ‘high alert’ when they don’t need to. During an EMDR session you will usually be asked to recall the traumatic memory whilst moving your eyes from side to side, or tapping yourself on alternate sides of your chest, knees, or arms.

Evidence suggests these movements help to get the trauma ‘unstuck’. We don’t know exactly why this works, but researchers believe it is likely to be because the movements trigger similar processes in the brain to those that take place during REM (Rapid Eye Movement) sleep (which facilitates emotional processing).

EMDR is a very well researched therapy and is recommended by NICE (National Institute for Health and Care Excellence) as an effective treatment for PTSD. It is also increasingly used to treat anxiety and depression.

Useful links

EMDR Association UK - Visit website

PTSD UK - Visit website

Acceptance & Commitment Therapy (ACT)

Developing psychological flexibility

Empirically based

Useful links:

Schema Informed Approach

Experiencing emotions and change safely

A balance

Useful links:

Cognitive Analytical Therapy (CAT)

Looking more deeply

Working together

Useful link:

Cognitive Behavioural Therapy (CBT)

Understanding unhelpful circles

A treatment of choice

Useful links:

Compassion Focused Therapy (CFT)

Shame and Self-criticism

Building a new skill

A integrative, research-based approach

Useful links

Eye Movement Desensitisation & Reprocessing Therapy (EMDR)

PTSD and Trauma

What is EMDR?

Useful links

Further information

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