Dr Rebecca ker, Counselling Psychologist BSc. DPsych.
Models of psychological therapy

Professionals tend to use jargon when desribing types of talking therapies. This page is intended to provide an introduction to different theoretical approaches to help you chose a professional that is right for you.

My website aims to introduce the different forms of psychological therapies, so hopefully it will make sense to say that usually my work with clients is underpinned by person-centred values. I aim to first of all create a relationship between us that feels safe for you to explore your inner world. This is not an easy thing to do, and I believe it is important that you feel understood, respected and listened to before deeper work can be achieved. When I have gathered information I will try to make sense of your experience by drawing upon all of my training as I do not believe that one theoretical approach holds all of the answers. The ‘formulation' of what's happening is a useful way of ensuring that your therapist understands you. We will do this bit together as it is important that your goals dictate where our sessions go.

In general terms, all of the approaches I describe inform my practice. With some, we will get straight down to CBT tools, with others, we will work together towards deeper levels of understanding drawing on approaches that focus on a person's early experiences more. At the heart of my approach is a belief that each person should be viewed as a whole, drawing on lots of relevant theory, whilst combining approaches in a way that is useful to the individual I am working with. Integrative therapy offers tailor-made therapeutic plans rather than assuming a ‘one-size-fits-all' approach to therapy.

Person-centred counselling (also known as "client-centred" or "Rogerian" counselling)

In simple terms: a strictly person-centred cousellor will aim to create an environment in which you feel safe to make sense of your own thoughts and feelings. They will be warm and supportive and let you do most of the talking. They will not offer advice but will gently encourage you. Person-centred therapists believe that we are all capable of healing ourselves, given the right conditions.

The theory: person-centred counselling was developed by Carl Rogers. Rogers asserts that all human beings have an innate tendency to develop towards their full potential, but that this potential is inevitably blocked or distorted by our life experiences. A person-centred counsellor aims to be deeply understanding (empathic), accepting (having unconditional positive regard) and genuine (congruent). The counsellor or psychotherapist in this approach aims to provide an environment in which the client does not feel under threat or judgement. This enables the client to experience and accept more of who they are as a person, and reconnect with their own values and sense of self-worth. This reconnection with their inner resources enables them to find their own way to move forward.

The counsellor or psychotherapist works to understand the client's experience from the client's point of view, and to positively value the client as a person in all aspects of their humanity, while aiming to be open and genuine as another human being. These attitudes of the therapist towards the client will only be helpful if the client experiences them as real within the relationship, and so the nature of the relationship that the counsellor and client create between themselves is crucial for the success of therapy.

CBT (Cognitive-Behavioural Therapy)

In simple terms: your therapist will help you notice your thoughts (cognitions) and help you understand the link between your thoughts, feelings and behaviour. This type of therapy can feel more structured and will offer concrete advice and tools to manage difficult feelings.

For example, imagine you saw someone you knew in the supermarket and they didn't wave or smile at you. If you made sense of them not greeting you by assuming that they didn't like you, the feelings and behaviour that followed would be negative (e.g. feel sad or angry and maybe avoid them next time you saw them). If you assumed that they didn't see you or that they were having a bad day you might feel and act differently.

This is a simple example that aims to illustrate that we experience the world subjectively. CBT helps a person challenge thoughts by looking for evidence for the thoughts and rules they have about life. It also helps identify behaviours and skills that can help a person to feel better.

The theory: CBT is a form of talking therapy that combines cognitive therapy and behavioural therapy. Research has shown that CBT can be as effective as medicine in treating depression and other mental health problems.

It is an approach that is favoured by the NHS as it often short-term therapy and can offer clients transferable skills to help deal with challenges that may arise in their future. CBT focuses more on the present than some other approaches.

Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behaviour, and emotional responses. Your thoughts, feelings, physical sensations and actions are interconnected, often trapping you in a negative spiral. CBT helps you stop these negative cycles by teaching you how to challenge negative cognitions and behave in different ways.

Schema therapy

In simple terms: The therapist will help you recognise how early childhood experiences impact adult thinking and coping styles. This approach is helpful for people who feel they are stuck in a pattern of behaviour that they would like to change. It is good for longer-term problems. I like this approach as it involves structure (like CBT) and also goes deeper than less directive therapies like person-centred approaches.

The theory: Schema therapy is an approach that was developed by Dr. Jeffrey Young for personality disorders, chronic depression, and other individual and couples problems. Schema therapy integrates elements of cognitive therapy, behaviour therapy, object relations, and gestalt therapy into one unified, systematic approach to treatment. The main theoretical concepts in Schema Therapy are Early Maladaptive Schemas (or just "schemas"), Coping Styles, Modes, and basic emotional needs.

Psychodynamic approaches

In simple terms: Psychodynamic approaches draw on the work of probably the most famous psychologists (Freud, Jung, Klein etc). The emphasis is on unconscious processes, with a purely psychodynamic therapist being a blank slate, on to which a client will bring unconscious conflict or repressed behaviours to the surface. Classic psychoanalysis can be quite intense and involve frequent sessions.

Psychodynamic approaches focus on the link between childhood experiences and adult behaviour and feelings. It is a deeper type of psychotherapy to the ‘here-and-now' focus of CBT, or solution-focused work, and involves a more analytical approach. This therapy is based on the idea that a great deal of an individual's behaviour and thoughts are not within their conscious control.

The theory: Psychodynamic therapy focuses on unconscious thought processes, which manifest themselves in a client's behaviour. The approach seeks to increase a client's self-awareness and understanding of how the past has influenced present thoughts and behaviours, by exploring their unconscious patterns.

The approach assumes that our behaviour and feelings as adults (including psychological problems) are rooted in our childhood experiences. All behaviour has a cause (usually unconscious), even slips of the tongue, therefore all behaviour is determined. Personality is made up of three parts (i.e. tripartite). The id, ego and super-ego. Behavior is motivated by two instinctual drives: Eros (the sex drive & life instinct) and Thanatos (the aggressive drive & death instinct). Both these drives come from the “id”. Parts of the unconscious mind (the id and superego) are in constant conflict with the conscious part of the mind (the ego). Therefore personality is shaped as the drives are modified by different conflicts at different times in childhood (e.g. during psychosexual development).

For more information about this approach I recommend the following websites:

Mindfulness and Acceptance and Commitment therapy (ACT)

In simple terms: These approaches are sometimes called ‘third-wave’ approaches as they are relatively new and were developed after CBT (the ‘second-wave’ approach). These approaches incorporate some ancient philosophies (e.g Buddhism). These approaches encourage people to accept that a normal part of being human is to experience suffering.

Mindfulness is a way of living in the present; recognising the sensations in the body and the thoughts we have by accepting them and being in the present.

ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT teaches them to "just notice", accept, and embrace their private events, especially previously unwanted ones.

The theory: Examples of third-wave CBT interventions include ACT, dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy and meta-cognitive approaches among several others. Rather than focusing on changing psychological events directly these interventions seek to change the function of those events and the individual's relationship to them through strategies such as mindfulness, acceptance, or cognitive diffusion For example, mindfulness skills can help a person to listen to their body and stay in the present. Acceptance is taught as an alternative to experiential avoidance. Acceptance involves the active and aware embrace of those private events occasioned by one's history without unnecessary attempts to change their frequency or form, especially when doing so would cause psychological harm.

As a simple way to summarise the model, ACT views the core of many problems to be due to the concepts represented in the acronym, FEAR:

And the healthy alternative is to ACT:

For example, anxiety patients are taught to feel anxiety, as a feeling, fully and without defence; and encourage them to change their relationship with the bodily sensations.

For more information about this approach I recommend these websites:

Couple’s therapy or family therapy

In simple terms: Couple or family therapy is for people wanting to improve a specific relationship rather than work on themselves. It involves attending sessions together so the therapist can observe how a group (or a couple) are teogether (e.g: how they talk to each other, who takes the lead, if there are difference in how they see the world, what their roles are etc). The therapist may occasionally meet you individually to get an understanding of how each person makes sense of what is happening, but the focus is on understanding how the people interact and if those interactions can be improved.

The theory: Systemic therapy explores how systems (or families, couples or other relationships) operate. Interactions of groups are observed, and their interactional patterns and dynamics are analysed. The focus is not on an individual's presentation; it is on practically addressing current relationship patterns rather than analysing causes such as subconscious impulses or an individual's formative years. The therapist can introduce new ideas to encourage the development of new patterns and interactional styles.

For more information about this approach I recommend this website:

Integrative therapy

In simple terms: Integrative therapy is the approach I usally take (unless there is a reason why I feel a single theoretical approach would be more beneficial). Integrative therapy involves incorporating what is useful from a range of approaches. Some therapists call using different parts of different approaches being ‘eclectic' but I believe ‘integration' is the best way of describing my approach as there is a clear therapeutic plan and not just the borrowing techniques from different approaches in an ad-hoc manner.

The theory: Integrative Psychotherapists are trained in several different therapeutic approaches and will combine those techniques and schools of practice depending on the needs of their client. Integrative psychotherapy involves incorporating theory and approaches of different schools of psychology. Integration happens at a philosophical level, informed by an understanding of an individual's presentation.

Integrative therapists believe that a person needs to be viewed as a whole and will formulate a client's presentation in a way that encompasses different schools of psychology in a holistic way. Integrative Psychotherapy refers to the bringing together of the affective, cognitive, behavioral, and physiological systems within a person, with an awareness of the social and transpersonal aspects of the systems surrounding the person.

For more information about this approach I recommend this website