Therapy

Clinical psychologists are trained in a range of evidence-based therapy models.

The therapy models described here are often used by clinical psychologists in an integrative way within a coherent and individualised treatment approach, which is uniquely developed for each client. These therapy models all have a strong evidence-base. 

In recent years, CBT has developed and expanded to incorporate what is referred to as ‘third wave CBT’ approaches including Compassion Focused Therapy (CFT), Acceptance and Commitment Therapy (ACT) and Mindfulness Based Cognitive Therapy (MBCT). Each of these therapy models have developed their own evidence base through continual research into their clinical effectiveness, which is documented in a number of professionally recognised and peer reviewed journals. Psychologists working with these approaches teach strategies that enable people to broaden their recognition of the internal ‘chatter’ and visual imagery that occurs within the mind, and to understand the impact of their interpretations on how they feel inside.

These approaches have been found to be very helpful for people who struggle with self-criticism and feelings of hopelessness, shame or anxiety. It has been shown through research that mindfulness strategies and the cultivation of self-compassion can have a profound impact on one’s attitude towards themselves, their experience of the world around them, their connection with other people, and the expectations that they carry about their future. These changes can have an enduring impact on the overall quality of one’s life.

Dr. Sara Hirst is experienced in providing detailed assessment and psychological therapy for a wide range of difficulties and within a range of evidence based therapy models.

Sara works with adults on an individual basis. Following the initial consultation, if therapy seems like the right step, sessions are usually offered on a weekly basis. Once progress has been established, this can sometimes be reduced down to fortnightly session if this frequency works better towards the end of therapy. Below is a description of the main psychological therapy models that Sara is trained in. Depending on the needs of the client and the individual formulation of their difficulties, one of these models may be used in its pure form or in an integrative way alongside elements of other therapy models to ensure that the work is meeting the client’s individual needs. This is always done in a transparent and collaborative way with the client being aware of what is informing the content, direction and pace of the work.   

Types of Therapy

Cognitive Behavioural Therapy (CBT) 

Cognitive Behavioural Therapy (CBT) is a psychotherapy that is based on the understanding that the way an individual experiences a situation is more closely connected to their interpretation of it than the reality of the situation itself.

One important part of CBT is helping clients to gradually change certain thinking patterns that can contribute to their distress, and to change their behaviour in particular situations so that this gradually reduces the kinds of experiences that appear to confirm their fears, leading to lasting improvements in their mood and functioning in daily life.

CBT uses a variety of cognitive and behavioural techniques, but it isn’t defined by its use of these strategies. The approach includes problem solving, enhancing the ability to recognise changes in mood and the presence of self-defeating thoughts, alongside the development of a range of coping strategies that have been shown to be effective in helping people manage and reduce levels of distress and increase their quality of life. CBT is a collaborative therapy, meaning that the client and therapist work together in partnership to learn to recognise the patterns in the client’s thinking and how they respond to situations, in order to understand how these patterns have developed, and to find ways of coping without falling into these patterns so frequently. The approach often involves practice between sessions, to enhance the gradual progress towards manageable and realistic goals, ultimately helping people to move towards long term goals and resolve issues that led them into therapy. This approach is a flexible one. Therapy is individualised and depends on the person’s abilities, preferences and situation. The therapy process is collaborative and transparent, enabling the client to feel informed and in control . CBT is recommended by the National Institute for Clinical Effectiveness (NICE) for a wide range of mental health problems. Please see the Department of Health and Social Care for more information.

CBT has been found to be as effective as medication in treating problems such as anxiety and depression. CBT can be used alone or in conjunction with medication, depending on the severity and nature of the client’s problems.

Eye Movement Desensitisation Reprocessing (EMDR)

Eye Movement Desensitisation Reprocessing (EMDR) is an integrative psychotherapy approach that has been extensively researched and shown to be effective for the treatment of the after effects of trauma in many cases.

EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical injury.  When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed though, healing resumes. The theory underlying EMDR suggests that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health but if the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound can struggle to heal, causing intense suffering.  Once the block is removed though, healing can resume. Using the procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.

There has been a substantial amount of research done on EMDR therapy and it is now recognised as an effective form of treatment for trauma and other disturbing experiences by the World Health Organisation. EMDR therapy is an eight-phase treatment. Eye movements, or other bilateral stimulation (moving from side to side), are used during one part of the session.  After the clinician has determined which memory to target first, she or he asks the client to hold different aspects of that event or thought in mind and to use his or her eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, an assault victim shifts from feeling horror, and possibly shame, to holding the firm belief that, “I survived it and I am strong.”  These insights result from the client’s own accelerated intellectual and emotional processes. Clients can conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, clients’ thoughts, feelings and behaviour are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is an empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behaviour change strategies, to increase psychological flexibility.

Psychological flexibility means contacting the present moment fully and changing behavioural responses so that one’s actions are more in line with one’s personal values.

ACT helps people to understand the subtle ways in which language can entangle them into futile attempts to challenge, resist or block their own thoughts or feelings. Through metaphor, paradox and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories and physical sensations that have been feared and avoided. Clients gain the skills to accept these private events, develop greater clarity about personal values and commit to behaviour change.

Compassion Focused Therapy (CFT)

Compassion Focused Therapy (CFT) is a psychotherapy that integrates techniques from Cognitive Behavioural Therapy with concepts from evolutionary psychology, social psychology, developmental psychology, Buddhist psychology and neuroscience.

It was developed to help those who suffer from high levels of self-criticism and shame. It seeks to enable people to cultivate kinder feelings towards themselves and others, and to feel safe and capable in a world that can sometimes seem overwhelming. Clients with backgrounds that involve neglect, abuse and trauma can sometimes suffer from very high levels of shame and self-criticism that require a therapeutic approach which addresses the intense emotional impact of these experiences and the ways in which shame and self criticism get maintained. Compassion Focused Therapy can help people who struggle with deep feelings of shame and an unrelenting inner critic, alongside a difficulty in believing that the world is a safe place. Clients with these difficulties need support to develop their emotional resources, including ways of being able to soothe themselves and experience inner peace.

Mindfulness

Mindfulness-Based Cognitive Therapy (MBCT) is a therapeutic approach that has been shown to be effective in helping to prevent relapse in depression and the after effects of trauma.

What is mindfulness?

The word mindfulness means compassionate and lucid awareness, a sense of knowing what is happening in the external and internal world as it is happening. Most of us are more used to its opposite: mindlessness – times when we are not really conscious of what is going on, when we are most liable to make mistakes. Mindfulness means waking up and checking in to what’s happening so we can make wise choices.

In its more common usage in recent clinical literature, it has come to mean the awareness that emerges as a by-product of cultivating three related skills:

  1. Intentionally paying attention to moment-by moment events as they unfold in the internal and external world,
  2. Noticing habitual reactions to such events, often characterised by aversion or attachment (commonly resulting in over-thinking), 
  3. Cultivating the ability to respond to events, and to reactions to them, with an attitude of open curiosity and compassion.

Mindfulness meditation

Mindfulness is traditionally cultivated by the practice of meditation in which people learn to pay attention in each moment with full intentionality and with friendly interest. Meditation is not about clearing the mind, but rather coming to see the mind’s patterns. Daily meditation practice allows people to see the way in which certain patterns of mind lead to escalation of emotions, despite our best efforts to control them. It also allows us to see more clearly what sorts of actions lead to more wholesome outcomes in everyday life.

When people practice mindfulness meditation for any length of time, a number of qualities of their experience change. People say they feel more aware or awake, feel calmer and are more able to see clearly and gain freedom from their own emotional patterns and habits. They feel freer to be more compassionate to themselves and to others. The early research trials conducted by Jon Kabat-Zinn and his colleagues had shown that this approach could be highly effective for patients who suffered long-term physical health conditions that had been destroying the quality of their lives (Kabat-Zinn, 2013).