Therapeutic Approaches Offered

Acceptance and Commitment Therapy (ACT)

ACT is a form of cognitive behavioural therapy which helps clients to let go of the struggle with negative thoughts and feelings so that they are freer to pursue what is important and meaningful to them. Acceptance and Commitment Therapy aims to help clients to become more ‘psychologically flexible’. This means being fully present in the moment, aware and open to internal experience whilst taking action guided by personal values. The therapist will help clients to develop the following 6 processes central to ACT:

• Consciously connecting with what is happening right now (rather than dwelling on the past or worrying about the future)
• Acceptance of thoughts, feelings, or physical sensations (rather than struggling with them, resisting them or avoiding them)
• Distancing, stepping back or ‘de-fusing’ from thoughts, letting them come and go as they (rather than getting attached to them, taking them literally or attaching significance to them)
• A perspective-taking sense of self that observes and notices (rather than always being governed by the often crticial, thinking part of the brain)
• Identification of values that are personally meaningful
• Commitment to taking action that is consistent with personal values

Evidence Base for ACT

ACT has a strong history of empirical evaluation; both outcomes of ACT therapy and processes of change have been researched. There are around 60 randomized controlled trials (the gold standard research method) published or in press. Studies indicate ACT is an effective treatment for a variety of difficulties including anxiety, depression and chronic pain. ACT is a therapy on the American Psychological Association Division list of empirically-based treatments. Further information regarding ACT research can be found on the website of the Association for Contextual Behavioural Science.

Mindfulness Based Cognitive Therapy

Mindfulness has been defined as: “Paying attention, on purpose, in the present moment and non-judgementally” (Kabat Zinn, 1990). It is orientation to thoughts and feelings which involves observing inner experiences without attaching to them, but instead accepting them and allowing them to pass.

Mindfulness practice helps us to better understand patterns of thinking and feeling so that we can recognise at an early stage when we start to feel distressed. Mindfulness can help people move away from the tendency to get drawn into automatic reactions to thoughts by increasing awareness that thoughts are just thoughts and not an accurate reflection on reality. By learning to focus attention on what is happening right now, we can avoid being drawn into dwelling on past events, which often brings up feelings of sadness or regret, or thinking about the future, which often triggers anxiety about ‘what ifs’. In learning mindfulness, which encourages an attitude of kindly curiosity towards inner experiences, we can also avoid getting caught in an internal struggle with thoughts and feelings, which can often be counterproductive.

Evidence-Base for Mindfulness

Mindfulness is a well-researched treatment approach with a strong evidence-base for improving mood as well as for reducing the negative impact of pain and health conditions. Comprehensive information on the mindfulness studies, including details of numerous published papers, can be found here: https://bemindful.co.uk/evidence-research/

Eye Movement Desensitisation and Reprocessing (EMDR )

EMDR is a psychotherapy approach which integrates elements of a number of evidence-based treatments. The approach addresses: i) the past experiences that have triggered trauma symptoms; ii) the resulting self-beliefs, feelings and physical sensations; iv) the positive, adaptive cognitions. Several of the clinical psychologist affiliates of Bristol Psychology Services are EMDR therapists.

Treatment follows a standardised protocol which is only commenced after a careful period of preparation and resource-building. A key element of EMDR treatment is the ‘dual stimulation’ – the client is asked to focus on a bilateral stimulation (e.g. tracking left and right) whist simultaneously attending to past memories and associated feelings and physical symptoms. During that time, clients generally experience the emergence of insight, changes in memories, or new associations.

Evidence-Base for EMDR

EMDR (along with CBT) is recommended in the National Institute of Clinical Evidence (NICE) guidelines for the treatment of PTSD. There is a significant body of research, including 20 randomised controlled trials, indicating the efficacy of EMDR for the treatment of PTSD after a range of traumatic experiences. Further information about efficacy research including research lists can be found at the EMDR Research Foundation and on the EMDR Europe website http://www.emdr-europe.org.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy is one of the most commonly used psychological therapies. It is a collaborative, goal-focused intervention which helps clients to: i) better understand how beliefs, thoughts and behaviours affect feelings and physical symptoms and ii) change thoughts and behaviours so as to improve emotional well-being. CBT theory suggests that personal experiences (often in childhood) can lead to negative views of ourselves, the world and other people. In certain situations these beliefs trigger negative thoughts to automatically pop into our minds, causing a downward spiral in mood. As an example, if someone says hello to a friend but the friend keeps walk straight past them, they may think “He ignored me, he thinks I’m not interesting” and next time they see this person, they may look away. Over time they may avoid socialising which could lead to feelings of boredom and low mood, thwart opportunities to learn that the interpretation ‘I’m not interesting’ may not be accurate, and serve to confirm beliefs such as “I’m boring”.

During CBT clients are helped to identify, record and challenge unhelpful or inaccurate thoughts (for example “perhaps he didn’t see me”). Effective strategies for managing difficult feelings and unpleasant physical symptoms are also taught including relaxation strategies and paced goal setting. Practical ‘behavioural experiments’ are also important in CBT; these give opportunities to systematically test out predictions in real life scenarios.

Evidence Base for CBT

There is extensive evidence supporting the efficacy of CBT for a range of emotional difficulties. CBT is recommended as a treatment of choice for difficulties such as anxiety and depression by The National Institute for Health and Care Excellence (NICE).

Metacognitive Therapy

‘Metacognitive’ refers to beliefs about thoughts. Metacognitive therapy is based on the idea that emotional distress is caused by particular ways of responding to thoughts, namely worry, ruminating and a bias in attention in which there is a hyper-vigilance towards threat. This therapeutic approach is interested less in the content of thoughts and more in how a person thinks and their beliefs about thoughts.

In metacognitive therapy, people are encouraged to detach from thoughts so that they are aware of the act of thinking itself– this is referred to as ‘detached mindfulness’. Practical techniques are also taught to increase mental flexibility so that there is more choice about the focus of attention.

Evidence base for Metacognitive Therapy

Metacognitive therapy is a relatively new therapeutic approach but it has a growing empirical evidence base and research suggests it may be particularly effective for worry and anxiety. A detailed list of relevant research in this area can be found at the Metacognitive Therapy institute.

Narrative Therapy

As the name suggests, this form of therapy focuses on the meaning people make of their experiences in the stories they tell about their lives. Narrative therapy views people as experts in their own lives and assumes that people have skills and strengths that will help them to alter the relationship with problems in their lives. It is a very non-pathologising approach and client and therapist work collaboratively together. Diagnosis and labels are not important, instead, emotional difficulties are often ‘externalised’ or described as if separate entities, for example a narrative therapist may ask “when anxiety bothers you, what does it have you doing?”, rather than “when you are anxious, what do you do?” This is because anxiety is not viewed as a stable trait but rather as a separate entity. In helping clients to view problems as not part of them, this approach can be very empowering; freeing people from the potentially self-restricting and shaming impact of diagnostic terms. Clients are encouraged to see that they are not confined by their stories, opening up the possibility for change.

Narrative therapy is appropriate for both adults and children. Children can respond particularly well to the creativity of narrative therapy and the externalising approach. The shift in a child is often dramatic when a problem is given a name and its influence mapped out. A child who is ashamed and reserved when adults use words such as “you are very anxious” will quickly engage with enthusiasm in a conversation about the “worry monster”. The child can then rally with indignation against the difficulty, rather than being frozen with shame or overwhelmed by feelings of hopelessness.

Evidence Base for Narrative Therapy

There is a growing body of evidence regarding the effectiveness of narrative therapy. Further information about evidence for this approach can be found here: http://www.dulwichcentre.com.au/narrative-therapy-research.html

Family and Systemic Psychotherapy

Family and Systemic Psychotherapy or the abridged term, ‘Family Therapy’ helps people within a close relationship to safely share and reflect on thoughts and feelings so that they develop a better understanding of each other’s perspectives. Family Therapy aims to draw on people’s combined strengths so as to improve communication and bring about constructive, positive change. Family therapy doesn’t necessarily involve a therapist working with the whole family. Family therapists often work with couples and individuals as well as their wider family members and any other people who are important in the client’s life.

Family therapists may support people around: relationship difficulties including divorce and separation; the impact of illness on the family; family conflict; adjustment at life transitions and difficulties around school and college.

Evidence Base for Family Therapy

An overview of evidence-based research on Family and Systemic Therapy can be accessed on the Tavistock and Portman NHS Foundation Trust website:

Couples Therapy

Couples Therapy integrates several evidence based psychological approaches to explore problematic patterns in the relationship and help couples resolve problems. Therapists work with clients to create a shared perspective of their relationship. They may work with a couple to give them strategies to improve their communication, manage their emotions and give them strength and resilience in their problem solving. Therapists may also encourage a couple to reflect on thoughts and feelings and understand how they influence our patterns of interaction. The aim is to address the barriers that have stopped a couple from connecting in the way they used to.

Relationship distress is a common problem and is strongly linked to other psychological and physical health problems. Many couples find difficulties start after a painful event or illness, or following a significant life change. Couples therapy can help with depression and isolation, mental health issues and parenting issues as well as general relationship distress.

Evidence Base for Couples Therapy

Couples Therapy is recommended in the National Institute of Clinical Evidence (NICE) guidelines for the treatment of depression. It has also been evaluated in over 30 randomized control trials and has been found to be extremely effective in treating relationship distress as well as lowering levels of depression and conflict.

Mentalization Based Treatment for Families (MBT-F)

Mentalization Based Treatment for Families (MBT-F) is a therapeutic approach which focuses on improving family life. The main focus of the intervention is on the relationships within a family, and how those might be improved. It supports family members to learn how to see things from different points of view, to talk and think about emotions and thoughts and to understand why family members may behave in certain ways. Research and experience shows that once this happens, communication and the ability to solve problems together will improve in the family.

Families may come to MBT-F with a whole range of difficulties including:

• Angry outbursts and tantrums
• Distressed or troubled children
• Tensions in family relationships
• Coping with loss and bereavement
• Difficulties with making or keeping friends
• Impact of divorce or separation on children

MBT-F is usually conducted over 6 to 10 meetings, most commonly fortnightly.

Evidence Base for Mentalisation Based Threatment for Families

Findings from studies so far indicate that 6 to 10 meetings with an MBT-F therapist can make a real difference for the majority of families working with this approach.

Existential Therapy

Existential therapy places emphasis on what are considered to be the ‘givens’ or core aspects of being human and the challenges or conflicts that these can pose to human beings. These ‘givens’ are: freedom; meaning; isolation; mortality.

Although we are free to choose many paths in life, for both conscious and unconscious reasons, we can often limit and confine ourselves. Existential therapy helps clients to understand and make sense of the decisions they make, enabling them to focus more on the here and to embrace choices available to them. This can lead to a more fulfilling, meaningful life.

Existential therapists attempt to set aside all preconceptions in order to gain a deep understanding of their clients’ experience and in turn help their clients to gain a deep understanding of themselves.

Evidence base for Existential Therapy

The foundations of existential therapy have a solid evidence base. A significant amount of research has focused on the connection between finding meaning or purpose in life and psychological well-being. In addition, the relational approach synonymous with existential therapy is evidenced to lead to good outcomes for clients. Further information on existential therapy can be found at http://existentialanalysis.org.uk/about-the-sea/about-existential-analysis/ 

Compassion Focused Therapy

Compassion-Focused Therapy (CFT) was developed to help people who have difficulties related to shame, self-criticism or self-loathing. It is an integrative therapy drawing together scientific understanding of how our minds work: evolution and attachment theory, neuroscience and emotional functioning. In addition to shame and self-criticism, it is useful with issues related to a history of emotional or physical abuse, difficulty believing the world is a safe place or finding it hard to trust others, which can manifest in issues with anger, self-esteem, depression or anxiety.

A therapist working from CFT approach creates a safe, kind and accepting therapeutic relationship. In CFT the therapist then pays particular attention to developing a better view of difficulties as understandable human struggles. From that place, the therapist works on developing more safeness and soothing, self-kindness, warmth, wisdom and strength. It may be necessary to overcome certain barriers to compassion and slowly develop emotional resources and distress tolerance in order to feel safe. We can all learn how to feel safe and capable.

Evidence base for Compassion-Focused Therapy

CFT is a relatively new therapeutic approach but it has a growing empirical evidence base. Articles on theory and research can be found at the Compassionate Mind Foundation.

Positive Behaviour Support (PBS)

Positive Behaviour Support (PBS) is an approach for working with both adults and children, most often those with learning disabilities and or an Autistic Spectrum Disorder, when behaviours for the person and the people around them are experienced as challenging. PBS conceptualises all behaviour as a form of communication and the focus of PBS is on finding out what the function of a behaviour is; what someone is communicating through their behaviour. PBS uses knowledge that comes from applied behaviour analysis to assess behaviour and then work with the person and people around them to think about how needs can be communicated and met in other ways. For example, by making changes to the the environment around the person or supporting the development of skills to cope in more helpful ways. PBS keeps the person whose behaviour is thought of as challenging at the centre of thinking and planning, always with aim of reflecting what is important and valued by them. The aim is to create a positive behaviour support plan which highlights the reason for behaviour and ways of supporting a person. Challenging behaviours can be connected to mental health difficulties or past trauma and other approaches which might be used to help with these difficulties can be easily integrated with PBS. PBS is often used when accessing talking therapy or reflecting on difficult behaviour is not easy for an individual. PBS is not dependent on a child or adult telling others verbally what is happening to them and therefore gives a different, less direct way, of finding out what may be happening and then usefully helping.

Evidence Base for PBS

PBS has a strong evidence base for work with those with learning disabilities and ASD. Further information about this approach can be found through BILD who also provide a short animation about positive behavioural support.

Play Therapy

“Play is the child’s symbolic language of self-expression and can reveal (a) what the child has experienced; (b) reactions to what was experienced; (c) feelings about what was experienced; (d) what the child wishes, wants, or needs; and (e) the child’s perception of self.” – Garry L. Landreth, Play Therapy: The Art of the Relationship.

Play Therapy is a form of Psychotherapy used with children and adolescents requiring support in managing difficult feeling which may be associated with a wide number of reasons. Play Therapy uses a variety of Play and Creative Art techniques to help the child make sense of their world and everything that is going on in it. During the sessions, the use of toys, and other creative materials supplied by the therapist, engender free expression at a level that the client feels most comfortable at. This will often include using a mixture of; drawing, paint work, clay work, sand tray, music, movement, drama and role play. Play therapists work systemically with the client, meaning that they will take into consideration the wider social and environmental factors of the client such as school, siblings, peers and family in order to better understand the presenting issues.

Evidence Base for Play Therapy  

Play Therapy is a well-researched approach for using with children aged 3 to 16 years old who are experiencing a wide range of difficulties.

https://www.bapt.info/play-therapy/ethical-basis-good-practice-play-therapy/

There is comprehensive information about Play Therapy being used worldwide across many difficult socio-economic backgrounds measuring the benefits and effectiveness of Play Therapy including numerous published papers which can be found here:

https://www.evidence.nhs.uk/search?q=Play+therapy https://playtherapy.org.uk/research/research1

https://www.a4pt.org/page/EvidenceBased

Music Therapy

“Music therapy is the use of sounds and music within an evolving relationship between client/patient and therapist to support and develop physical, mental, social, emotional and spiritual well-being”

Leslie Bunt. (Bunt & Hoskyns (2002) The Handbook of Music Therapy. London: Routledge.)

Music Therapy is a type of person centred psychotherapy – much the same as most clinical talking or creative therapies – in that it provides a framework in which the client is supported to discuss or reflect upon the issues they wish to bring to the session, at their own pace, in order to initiate the changes necessary for health.

Music therapy is suitable for both children and adults in a wide range of settings and sessions are goals are flexibly and collaboratively adapted to the particular needs of the client.

It should be emphasised that the music in the session is not played to the client but with, and acts much in the same way as words might: giving form to the therapeutic relationship and communication. Clients don’t have to do use or play music in the session and no musical experience is required at all. The sessions are usually a mix of both music and words and often, according to the preferences of the client.

Evidence Base for Music Therapy

For a compilation of research publications and resources regarding how, when and why music therapy works, please see: https://www.nordoff-robbins.org.uk/research-projects/evidence-bank/

Attachment Based Therapy

Dyadic Developmental Psychotherapy (DDP)

Dyadic Developmental Psychotherapy (DDP) is an attachment-based intervention. The approach was developed by Dan Hughes, a Clinical Psychologist, to help support adopted or fostered children struggling with the impact of developmental trauma resulting from neglect and abuse in their birth families. Central to DDP is a certain set of qualities bought to interactions to deepen emotional connections, summarised by the acronym ‘PACE’: playfulness (to bring enjoyment to the relationship); acceptance (to create psychological safety); curiosity (to express a desire to know the other more deeply); empathy (to communicate acceptance).

Evidence Base for DDP

DDP is a “science informed” model of treatment that uses relational processes consistent with a large body of neuroscientific research which shows that a highly nurturing, attuned, responsive form of parenting promotes healthy brain development and the formation of strong emotional bonds between parents and children.

Mentalization Based Therapy (MBT)

Mentalization Based Therapy (MBT) is a form of psychodynamic therapy. MBT aims to promote the development of ‘mentalizing’ and is based on the view that people’s difficulties are rooted in a loss of mentalizing. Mentalizing refers to one’s ability to be aware of, and understand, ones own and other’s mental states (thoughts, feelings, wishes, desires). It has been described as the ability ‘to see ourselves from the outside and others from the inside’. MBT was originally developed as an intervention for those with borderline personality disorder, although the application of the approach has since grown.

Evidence Base for Mentalisation Based Therapy

 Research has demonstrated that MBT is an effective treatment for clients with a diagnosis of ‘borderline personality disorder’. Growing research is also indicating its effectiveness with various other conditions, such as eating disorders, depression, and substance abuse.

Schema Therapy (ST)

Schema therapy (ST) is an integrative therapy, it combines elements from cognitive-behavioural, psychodynamic, attachment and gestalt models. ST considers one’s difficulties to be rooted in early life experiences, it specifically considers difficulties to have emerged from core emotional needs being unmet in childhood, which in turn give rise to self-defeating life patterns (schemas). These schemas are thought to drive unhelpful emotional, cognitive, and behavioural states in adulthood (modes).  The therapy aims to reorganise any unhelpful patterns and enable clients to meet their needs in healthy ways.

ST was originally developed as an intervention for those with a diagnosis of ‘personality disorder’ and other complex clinical difficulties. However, the application of the approach has grown, and it is now used to treat a variety of mental health difficulties. It is considered particularly effective when used with those with long-standing difficulties or with those who may have experienced limited success in other/ standard therapeutic approaches.

Evidence Base for Schema Therapy

Research has demonstrated the effectiveness of ST for treatment of clients who have a diagnosis of a ‘personality disorder’, particularly borderline personality disorder. There is some emerging research indicating the approach may be promising interventions or anxiety, OCD and PTSD, chronic depression, eating disorders, and substance misuse.