What We Do
Assessment
Psychological assessment is an opportunity to:
Understand yourself and your difficulties better, working with a psychologist to develop an initial theory of your experiences (sometimes called a ‘formulation’), through drawing on psychological theories and research.
Explore whether psychological ideas and concepts feel accurate and useful for you.
Assess your options for further professional support around any identified issues, including the NHS, 3rd sector and private practice routes. Increasing your access to informed choices.
Explore whether you feel you could work with a particular therapist, understand what type of psychotherapist you might need, and to support you with appropriate referral pathways in order to gain access to services. We can refer you to the service of your choice and will advocate for the right option for you.
Our assessment appointments are typically 90 minutes. With your permission, we will write to you afterward with a summary of the session and the available options to you. This allows you to take the time you need to make an informed decision on any further steps.
At the assessment stage our role for you is to enhance psychological understanding and informed choice.
Psychotherapy
Cognitive Analytic Therapy (CAT)
What is CAT?
CAT stands for Cognitive Analytic Therapy. It is a way of understanding ourselves through our key relationships and life events, and the patterns and strategies we developed to cope with life in response. As its name suggests, it does this by bringing together ideas and understandings from two different therapies: Cognitive and Analytic.
All human beings are hard-wired to use our early relationships with others in order to understand ourselves, other people, and the world in general. We are also designed to be adaptive in order to survive. We develop ‘patterns’ of thinking, feeling and responding to our experiences in order to be safe and manage our levels of comfort and distress. Sometimes our personality traits can be adaptive in our early lives but become less adaptive or ‘costly’ in other ways when we are adults. CAT is a therapy that is all about understanding ourselves, our patterns, and what we would like to change in more detail.
CAT is widely used as an effective therapy for a number of problems and experiences, and also as a personal development tool.
What is CAT like?
Depending on the length of your therapy there are usually 3 phases to a CAT approach.
The first phase involves you and your therapist understanding your experiences in a psychological way through exploring your early life, relationships and other key life events. You might also be asked to keep a diary during this phase. Your therapist will usually write a letter to you that they will share in person around the 4th session. You and your therapist may also create a diagram that helps in understanding certain patterns in your experiences through a ‘map’.
In the second phase of the therapy you and your therapist work together on identifying times where patterns from the letter and map are in action in your life, so that they can be better understood and begin to play out less problematically. This will include exploring the relationship you have with the therapist in addition to experiences outside of the therapy room.
In the third phase you and the therapist focus on developing ‘exits’ to any difficulties or problematic patterns by using the resources from phases 1 and 2. There is also a particular focus on endings throughout the therapy and exploring what this might be like for you. Your therapist will usually write to you with a goodbye letter at the end of the therapy which they will share in person, and the client is also invited to write a letter of their own.
CAT at its heart, is all about relationships. The relationship you have with yourself, the relationship you have with others, and the relationship you have with the therapist. Throughout all 3 phases these relationship dynamics are frequently attended to and explored.
How long is a CAT therapy?
CAT is a time-limited therapy, usually lasting between 4 and 24 weeks, depending on a person’s individual needs and their own manageable goals for change. This would usually be discussed in detail during the assessment. Therapies of 8, 16, or 24 sessions are common. The typical length is 16.
Sessions are usually weekly, but it may be possible to meet less frequently where appropriate.
Is CAT effective? – What is the evidence?
CAT was initially developed in the late 1980’s and early 1990’s to be a time-limited and effective psychotherapy in the National Health Service.
It is recommended as an evidence-based therapy for ‘personality disorders’ and ‘eating disorders’ by the National Institute of Health and Care Evidence (NICE), who develop the ‘best-practice’ treatment guidelines for NHS settings.
Therapy outcome studies of CAT have found it can be an effective approach for a number of problems and experiences, including:
- Personality difficulties
- Anxiety & Depression
- Eating difficulties
- Adulthood adjustment following childhood sexual abuse
- Dissociative experiences
- Jealousy
- Coping with long-term physical health conditions
You can read more about the effectiveness of CAT:
On the Association for Cognitive Analytic Therapy website:
In a 2009 review of available research studies:
https://www.acat.me.uk/reformulation.php?issue_id=5&article_id=85
In a 2014 published systematic review of the evidence:
How is CAT different to CBT?
Many modern psychotherapies are expressed in letters or acronyms. Unless you are trained in both approaches or have completed therapies as a client in both approaches, it is highly unlikely the similarities and differences between them will be apparent.
The article below may be helpful:
https://www.acat.me.uk/page/what+is+the+difference+between+cat+and+cbt
Cognitive Behavioural Therapy (CBT)
What is CBT?
Cognitive behavioural therapy, or CBT, encompasses a range of talking therapies based on the theory that thoughts, emotions, behaviours, and our physiological responses are all connected. If we change patterned responses in one of these areas, the theory is we can alter the others.
When people feel worried, stressed or low in mood, we often fall into patterns of thinking and responding which can maintain or worsen how we feel. CBT draws on psychological theory and evidence to help us understand the way our minds and bodies respond when we feel anxious and low. It has more of a ‘here-and-now’ focus than other psychotherapies – focusing on present ‘symptoms’ and the strategies required to cope with and manage them.
Cognitive Behavioural Therapies have been extensively researched and developed since their inception in the 1960’s. There are now several redevelopments of CBT including: Compassion-Focused-Therapy; Acceptance and Commitment Therapy; Metacognitive Therapy; and Schema Therapy. These therapies all differ in their aims, focus, underpinning theories and philosophies. It should always be clear what approach you and a therapist are using together and why.
What is CBT like?
After the assessment sessions, CBT therapy sessions usually begin by having a brief review of your wellbeing in-between sessions and checking-in with your therapist.
The client and therapist then construct a specific agenda of what the client wishes to work on for the remainder of the session.
CBT is an active therapy and is very task focused. There is a strong emphasis on self-monitoring and diary keeping exercises, completing questionnaires, introducing new cognitive strategies and behaviours, and setting up specific tasks or experiments with the support of your therapist.
CBT takes a particular type of scientific approach toward understanding and alleviating psychological distress. This means that there are usually individual treatment frameworks for different problems and experiences with specific tasks and time limits. For instance, there are distinct CBT approaches for social anxiety, panic attacks, depression, obsessive-compulsive difficulties, and many other specific problems. Although there will be some similarities between these therapies, they are all tailored to what the best available CBT research evidence suggests about how these difficulties are established, maintained and alleviated.
From the outset, your therapist will usually be able to explain the process of therapy for your specific circumstances in detail; including how many sessions will be required, and the specific tasks that will be worked through together. This often makes CBT popular in the NHS, research studies and with private healthcare providers because it is quantifiable and easy to measure.
How long is a CBT therapy?
CBT usually takes place across around 4 – 20 sessions. The length of therapy will depend on factors such as: the nature of your presenting difficulties; your goals and hopes for change; and whether this is your first therapy.
Therapies of 6-12 sessions are common for initial mental health presentations.
Is CBT effective? – What is the evidence?
CBT is recommended as an intervention by the National Institute of Health and Care Evidence (NICE), who develop the ‘best-practice’ treatment guidelines for NHS settings. NICE recommend CBT for the following difficulties:
- Anxiety (including social anxiety, phobia, panic attacks, and post-traumatic stress)
- Depression
- Obsessive Compulsive Difficulties
- Psychosis
- Bipolar
A 2012 systematic review study reported that CBT can be an effective therapy for a number of specific mental health experiences. The authors concluded that the strongest evidence for CBT was found for anxiety difficulties; the impact of stress on the body; bulimia nervosa; anger control problems; and generalised stress.
You can access this research article here:
How is CBT different to CAT?
Many modern psychotherapies are expressed in letters or acronyms. Unless you are trained in both approaches or have completed therapies as a client in both approaches, it is highly unlikely the similarities and differences between them will be apparent.
The article below may be helpful:
https://www.acat.me.uk/page/what+is+the+difference+between+cat+and+cbt
Therapies for Post-traumatic difficulties
What are ‘trauma therapies’?
Trauma therapies are specific specialised psychotherapies designed to help people understand and cope with life after trauma, including its psychological, emotional, spiritual and functional impacts.
These approaches are often grouped into:
- Reprocessing therapies – such as:
- EMDR
- Cognitive Processing Therapy
- Prolonged Exposure Therapy
- Narrative Exposure Therapy.
Each of these therapies differ in their respective approach, but they are all fundamentally developed for people whose memories of traumatic events continue to cause significant difficulties and distress.
- Somatic therapies – such as Sensorimotor Psychotherapy; or Somatic Experiencing therapy. These therapies focus much more on how trauma is held in, expressed through, and impacts on our bodies. These therapies focus much more on using an awareness of our physiology moment-by-moment to enable us to work through trauma using a combination of physiological techniques, and a body-orientated talking therapy.
- Integrative trauma therapy – Most practitioners use an overarching 3 phase approach for trauma work, of:
- Safety
- Reprocessing
- Reintegration.
Sometimes other psychotherapies such as EMDR or cognitive therapy are used to assist with particular phases of therapy, but the core of the framework is psychodynamic. This type of work tends to be longer-term, often 1-3 years, and is often best placed within the NHS or a specialist trauma therapy service, so that you have a good-enough network of support around you.
How long does trauma therapy last?
The length of trauma therapy depends on multiple factors: a person’s life history; their unique experience of life trauma(s); how the traumatic event has been processed, stored and organised by the body and mind; life events and adjustments since the trauma(s) occurred; and a person’s current life situation.
For many individuals between 4-24 sessions of a reprocessing therapy has been shown to reliably generate a good outcome. This is especially so for people who have experienced a single traumatic event, where the event has occurred in adulthood rather than childhood, and who have a good network of support.
For those of us who have experienced multiple traumatic events, at differing points in our development, with varying levels of support, alongside other common life stressors, trauma therapy can still be effective, but it may need a more considered process with a wider network of professional support.
A good assessment where you and your psychologist explore these areas together will be fundamental in making decisions about what type of approach may be best, and over what period of time.
Clinical Supervision
We are able to provide clinical supervision for individuals or small groups of psychologists / psychotherapists, including:
- ACAT accredited clinical supervision to therapists training in or providing Cognitive Analytic Therapy.
- Clinical supervision to therapists training in or providing Cognitive Behavioural Therapy, including CBT for experiences associated with psychosis and bipolar.
Most clinical psychologists and psychotherapists work with a diverse range of people and experiences, and may require supervision with the flexibility to be multi-modal and integrative. Please feel free to get in touch for a conversation about your requirements.
If we do not have capacity to provide clinical supervision or cannot meet at time that is convenient for you, we may be able to recommend another suitable colleague in your area.
Suitability for surgery consultation
The aim of this service is to:
Identify clients who may be at risk of psychological harm from pursuing a surgical procedure.
Support surgical consultants in considering their decision-making processes regarding a patient’s suitability for surgery.
Support patients in making a self-determined, reasoned decision regarding surgical procedures.
Clients will usually meet with a psychologist for a 90-minute session. At the end of the appointment, the client and psychologist consider the available information together and discuss recommendations for the surgical procedure, post-operative recovery window, and any additional psychological support that may be required. These recommendations are then provided to the surgeon in a report. If necessary, the surgical team can request further advice or consultation.
What is Clinical Psychology?
Clinical Psychology is the application of psychological theory, research, and therapy in order to:
Understand mental health experiences.
Reduce psychological distress.
Promote wellbeing and adjustment in response to existential difficulties and life events.
Understand psychological and neurological development across the lifespan, from in-uterine life to the experience of death and dying.
Understand variations in individual differences – ‘personality’; ‘intelligence’; cognitive development.
In order to be considered competent to practise, Clinical Psychologists are required to have accreditable skills in at least two different psychotherapies, although many Clinical Psychologists become trained in several over time.
The training routes for Clinical Psychologists can differ slightly, but most are required to undertake an accredited 3-year degree in Psychology before seeking several years additional clinical and research experience. This may include paid employment as an assistant psychologist and / or a Masters degree. This allows prospective psychologists to demonstrate suitability for their accredited Doctoral training, usually over a further 3 years. The typical training route from degree to post-doctoral qualification is a minimum of 8 years.
Clinical Psychologists are trained to take a critical stance toward knowledge, research and evidence. Although they may have a main or preferred approach, they should be able to discuss the strengths and limitations of psychological ideas and psychological therapies for your unique circumstances.
All UK Clinical Psychologists are required to be registered Practitioner Psychologists with the Health & Care Professions Council. They may also apply to be Chartered Psychologists with the British Psychological Society.
You can find more information on how to consider choosing a psychologist or psychotherapist in our articles section.
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