I predominantly use cognitive behavioural therapy (CBT) as the main model of treatment whilst incorporating third wave CBT treatments such as acceptance and commitment therapy (ACT) mindfulness and compassion focussed therapy (CFT). For single event and multiple traumas I use either trauma focussed CBT (TF-CBT), narrative exposure therapy (NET) or eye movement desensitisation and reprocessing EMDR and am happy to use EMDR to treat a variety of presentations in line with the emerging evidence base. Underpinning much of my work with clients are positive psychology and solution focussed frameworks.
Whilst individual therapy may be viewed as a process traditionally only involving the client and therapist, I often offer opportunities for clients to bring along a person who is important or close to them at some point in therapy. This is certainly not mandatory however it can be a useful way of enhancing the therapeutic gains made. I also offer therapy to couples experiencing relationship difficulties. I am happy to offer therapy face to face or via e-therapy
CBT, or Cognitive Behavioural Therapy, is a talking therapy that has been proven to be very effective in treating a wide range of mental health difficulties for children, teenagers and adults. The basis of CBT is that what people think can affect how they feel and how they behave. The role of therapy is for the client and therapist to work together to identify any unhelpful thoughts or behaviours. The aim would be to explore whether these can be changed and to then change them to more helpful and adaptive thoughts or behaviours.
The cognitive part of CBT specifically refers to the meaning created by people when they think about situations, symptoms and events in their lives, which in turn can create beliefs about themselves, others, the future or the world. The behavioural part of CBT refers to a response to those situations, such as avoidance and reduced activity for example.
The client and therapist work together to ensure that the client feels safe enough to test out their beliefs, fears, assumptions and reactions to events. Through the use of cognitive techniques and behavioural experiments, people can become more aware of their reactions to events and how to adopt other ways of perceiving and reacting.
By focussing on the here and now CBT helps to directly target distressing symptoms, reduce distress, challenge thinking patterns and promote helpful responses. The goal of CBT is to offer goal orientated, problem-focussed skills-based treatment interventions and evaluate their impact on everyday life. Common elements of CBT are agenda setting, homework and behavioural experiments and thought challenging
Trauma focussed Cognitive Behavioural Therapy or TF-CBT is a form of CBT which is specifically focussed on working on the experience of trauma. Most people in their lives will experience some form of trauma. For some these experiences may be threatening, scary or overwhelming and the effects of them may linger but with time the distress may ease. For other people the events may have such an impact that they take over and have a severe impact on a person’s ability to function in day to day life. In both cases TF-CBT will be useful to help clients work on the memories, beliefs or feelings from trauma, any sense of current threat that may exist after the event, avoidance behaviours and to help change beliefs in self, others, the world or the future. Common elements of TF-CBT are working collaboratively to ground and stabilise oneself, working directly with the distressing memories and beliefs which arose from the trauma through exposure and reliving and learning how to reclaim your life after the trauma.
Eye movement Desensitisation and Reprocessing or EMDR is a distant therapeutic approach which has a large evidence base for its effectiveness for trauma. However research is growing to show its effectiveness with many other difficulties. EMDR involves bilateral stimulation of the brain when thinking about a difficult memory. This is traditionally done by looking at the therapists hand or finger as it is passed back and forth from side to side, although there are other ways this can also be done such as tapping or paying attention to sounds which occur in sequence from left to right. This unique therapeutic approach is meant to enhance the processing of distressing memories. The number of sessions required will depend on each individual presentation.
Acceptance and Commitment Therapy or ACT is seen as a third wave therapy in the CBT tradition, which emphasises a focus on changing the relationship to thoughts and feelings using mindfulness and acceptance strategies. ACT aims to expand a person’s behavioural repertoire by increasing ability to respond flexibly to situations. This therapeutic approach particularly focusses on contact with the present moment, values, committed action, seeing the self as context, defusion and acceptance. ACT does not have symptom reduction as its goal, instead one of the core messages of ACT is to accept what is out of one’s personal control and commit to action that improves and enriches one’s life. Through mindfulness skills one learns to deal with painful thoughts and feelings in such a way that they have less impact, as well as helping to clarify what is truly important through values focussed work.
Compassion focussed therapy or CFT is particularly useful for people who experience high levels of shame or self-criticism and who have a high level of difficulty in being kind, warm or self-compassionate to themselves or others. People who are sensitive to rejection and fear being blamed from others also tend to have a lower ability to self sooth. These clients may also be skilled at CBT and may for example be able to generate alternative rational views but feel no change in their emotion. CFT explores three systems 1) threat and protection systems; 2) drive, resource-seeking and excitement systems; and 3) contentment, soothing and safety systems. These systems can overtime become unbalanced and one of the main goals in CFT is to work on rebalancing them, with the focus being on working compassionately to enhance the social safeness and soothing system. Attributes of compassion which are explored are care for wellbeing, sensitivity, sympathy, distress tolerance, empathy and non-judgement. Clients learn to adapt compassionate skills such as compassionate attention, reasoning, behaviour, imagery, feeling and sensation.
Narrative exposure therapy
‘We live our lives according to the stories we tell ourselves and the stories we are told by others. People do not usually step outside these dominant stories’ (Micheal White, 1990). When these stories focus on negative or traumatic experiences a sense of persistent distress can arise. Narrative exposure therapy or NET is a treatment mainly for individuals who have experienced complex and multiple traumas. It is based on the idea that how a person tells their own life story influences how they perceive their experiences and wellbeing. Through therapy, a narrative can develop which looks at life experiences both negative and positive. Flowers and stones are used to illustrate elements of life’s journey. In this way people have the freedom to reflect on their whole life, cultivating a feeling of personal identity and creating a coherent autobiographical story which contextualises people’s experiences and potentially fills in details of fragmented memories. A traumatic memory can be narrated without losing connection from the present moment. A documented autobiography is created for the patient to keep.
Mindfulness is the awareness that emerges through paying attention on purpose, in the present moment, and non-judgementally to the unfolding of experience moment by moment. (Jon Kabat-Zinn, 2003). Mindfulness is a form of self-awareness training which has been adapted from Buddhist practice in mindful meditation. We often find ourselves thinking about what has been or what will be, which can cause a great deal of distress to us in the current moment. Focussing on the present moment can be difficult and we may find that our mind wanders and is not easily controlled. This is often referred to as our ‘monkey mind’ and initial practice in mindfulness will increase our awareness of how much our minds fluctuate in mostly unhelpful ways. However through continued practice in mindfulness we strengthen our ability to pay attention in the present moment and to stay in the present moment. In turn our distress lessons, but our sense of wellbeing increases.
E-therapy is a convenient way to access therapy in the comfort of your own home. It allows you to talk freely and openly in a place that is familiar to you and cuts out the need for travelling. It is particularly useful for people who find it difficult to travel due to physical health difficulties or a heightened sense of anxiety. You simply need a device with a good internet connection and access to SKYPE to be able to access therapy online.