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Therapy

Types of therapy explained

Therapy is not one method. Psychologists draw on a number of evidence based approaches and choose between them according to the problem, the person and what has already been tried. This page explains the main ones in plain language so you know what is being suggested and why.

Most therapy at Ivy is integrative in practice. A course of work might begin with one approach and borrow from another as the picture becomes clearer. What matters more than the label is that the method fits the problem and that you and your psychologist agree on what you are working towards.

• CBT
• ACT
• DBT
• EMDR
• Schema therapy
• Solution focused
• ERP
• IPT
• Motivational interviewing
• Parent and family work
• Mindfulness based approaches
• Psychodynamic therapy

Cognitive behavioural therapy

CBT

CBT works on the relationship between what you think, what you do and how you feel. Sessions are structured and usually involve tasks between appointments, because most of the change happens outside the room. You learn to notice unhelpful thinking patterns, test them against evidence rather than argue with them, and change the behaviours that keep a problem going, particularly avoidance.

It has the largest evidence base of any psychological therapy and is a common first choice for anxiety, depression, panic, insomnia and stress. It suits people who like a clear framework and are willing to practise between sessions.

Acceptance and commitment therapy

ACT

ACT takes a different angle. Rather than changing the content of difficult thoughts, it works on your relationship to them, so that anxiety, grief or self criticism have less pull on your behaviour. The work is organised around values, which is to say what you want your life to stand for, and around taking action in that direction even when uncomfortable feelings are present.

It is often useful for chronic pain, long standing worry, perfectionism, burnout and situations that cannot simply be fixed. People who have done CBT and found themselves stuck in an argument with their own thoughts frequently find ACT a better fit.

Dialectical behaviour therapy

DBT and DBT informed skills work

DBT was developed for people who feel emotions intensely and find them hard to regulate, and it pairs acceptance with change. It teaches four sets of skills, which are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.

Full DBT programs include individual therapy, a skills group and phone coaching. Much of what is offered in private practice is DBT informed individual work, which uses the same skills without the group component. It is commonly used for emotional dysregulation, self harm, unstable relationships and borderline personality presentations.

Eye movement desensitisation and reprocessing

EMDR

EMDR is a structured trauma therapy. You bring a distressing memory to mind while attending to a side to side stimulus such as eye movements or alternating taps, and the memory is processed in stages until it no longer carries the same charge. You are not required to describe the event in detail, which is part of why some people find it more tolerable than talking therapies.

It is recommended in treatment guidelines for post traumatic stress disorder, and is also used for single incident trauma such as an accident, and for distressing memories that continue to intrude.

Schema therapy

Schema therapy is a longer term approach for patterns that keep repeating. It identifies schemas, which are the templates about yourself and others formed early in life, and the coping styles built around them. Work involves recognising a pattern as it plays out, understanding where it came from, and building a healthier response through both cognitive and experiential techniques such as imagery and chair work.

It is designed for entrenched difficulties rather than a specific recent problem, including personality difficulties, recurring relationship patterns and depression that has not responded to shorter term therapy.

Solution focused brief therapy

SFBT

Solution focused therapy spends very little time on the history of a problem and most of it on what a better situation would look like and what is already working. Questions are practical. When has this been less of a problem, what was different then, and what is the smallest step towards more of that.

It is brief by design, often a handful of sessions, and works well for a specific goal, a decision point or a period of adjustment. It is less suited to complex trauma or long standing difficulties.

Exposure and response prevention

ERP

ERP is the specific behavioural treatment for obsessive compulsive disorder. You approach the situations that trigger obsessions in a planned and graded way while deliberately not performing the compulsion or reassurance seeking that usually follows. Over repeated practice the anxiety subsides on its own, which is the learning the treatment depends on.

It is demanding and it is also the most effective treatment available for OCD. Graded exposure on the same principle is used for phobias, panic and school refusal.

Interpersonal psychotherapy

IPT

IPT treats depression by working on the relationships and life transitions around it rather than on thinking patterns directly. Sessions focus on one or two areas, usually grief, a role transition such as becoming a parent or losing a job, a dispute with someone close, or difficulty forming relationships.

It suits people whose low mood is clearly tied to what is happening between them and the people in their life.

Motivational interviewing

MI

Motivational interviewing is a way of having conversations about change when someone is in two minds about it. Rather than persuading, the psychologist helps you articulate your own reasons for and against, and resolves the ambivalence in your own words.

It is used with substance use, health behaviour change and any situation where advice has already been given and has not helped. It is frequently a first phase that makes other therapy possible.

Parent and family based work

With children, a good deal of the effective work happens through parents. This includes behavioural parent training for defiance and disruptive behaviour, coaching parents to respond to anxiety in ways that build confidence rather than accommodate avoidance, and family based approaches for eating difficulties and school refusal.

Younger children in particular often make faster progress when the adults around them change what they do, and this is a feature of the evidence rather than a shortcut.

Mindfulness based approaches

MBCT and MBSR

Mindfulness based cognitive therapy combines meditation practice with cognitive therapy and has the strongest evidence for preventing relapse in recurrent depression. Mindfulness based stress reduction is a related program used for stress and chronic health conditions. Both involve regular home practice, which is where the benefit comes from.

Psychodynamic and emotion focused therapy

Psychodynamic therapy looks at how earlier experiences and patterns outside awareness shape current relationships and reactions, including the relationship with the therapist. Emotion focused therapy works directly with emotional experience in session to shift stuck feelings. Both tend to be more open ended than CBT and less driven by between session tasks.

They suit people interested in understanding themselves more deeply, and those for whom symptom focused approaches have not been enough.

How an approach gets chosen

The first few sessions are largely about working out what is happening and what would help. Your psychologist will explain what they are recommending and why, and it is entirely reasonable to ask. If something is not working after a fair trial, that is information, and the plan should change.