Therapeutic approaches

The one single factor that has consistently been shown by research to be predictive of positive therapeutic outcomes is the nature of the therapeutic relationship. So how safe we feel with our therapist is probably going to be the most important ingredient for therapy to be helpful. Despite this, psychologists have a tendency to develop particular therapeutic models to try and explain mental health problems, and to guide them in therapy sessions. I sometimes compare these different models to different languages that can often say the same things, but with crucial nuances that will speak to one person and not another. Here's a quick overview of some of the more popular therapeutic languages I work with. 

Cognitive behavioural therapy (CBT) is a model-driven, structured approach, which focuses on treating identified current problems. An understanding of the development and maintenance of psychological symptoms is achieved collaboratively by examining the interaction between thoughts, feelings and behaviour in the here-and-now. It rests on an awareness of historical and environmental influences. Often it is useful to notice vicious circles that  maintain a problem, as well as identifying unhelpful thinking styles that may have developed as a result of a difficult experience or belief system. Solutions are found in changing patterns of behaviour and challenging existing thinking styles in order to improve emotional wellbeing, as well as developing strategies, and learning tools to better manage emotions.  
This model is well researched and has a lot of evidence to back it up. It lends itself to the development of self-help manuals and computerised programs, which can be found on the internet (see the self-help page).
 
EMDR stands for Eye Movement Desensitisation and Reprocessing and has its origins in treating PTSD, though it is now used more widely to treat a range of psychological difficulties. EMDR is based on targeting and processing specific traumatic memories, which are not encoded the same way by the brain as more 'normal' memories due to the often overwhelming feelings felt at the time. They tend to remain in a more primitive, and sometimes non-verbal, form and can evoke strong feelings when triggered, as though the event was being experienced again. This results in often overwhelming, or 'oversensitive' reactions in the present in relation to events or triggers that are in some way reminiscent of the original trauma.
EMDR uses bilateral stimulation, such as eye movements similar to those we make in REM sleep, to help the brain reprocess these undigested memories whilst remaining safe and connected to the present. In essence we teach our brain to update the traumatic experience into a memory that is firmly in the past. This also allows us to reinterpret and challenge problematic beliefs about ourselves that may have been connected to the traumatic experience. Resolution is reached when the original memory no longer evokes overwhelming feelings. Functional brain imaging techniques show that the more developed parts of the brain (where our thinking, personality and problem-solving reside) become more active, and the more primitive parts of the brain where strong feelings and memory are based become less active after EMDR therapy. This reflects a better integration of traumatic experiences.
 
Systemic theory developed out of communication theories and later gave rise to family therapy. It focuses on locating problems between people, in the interaction, rather than within a person. It places emphasis on the context and the various systems surrounding a problem, including family relationships, belief systems, wider social structures and cultural differences. It can be used as an approach with individuals as well as with families or organisations. Solutions are sought through identifying patterns of interactions and exploring different ways of relating to one another or indeed with the "problem". It allows for multiple perspectives and encourages people to develop their own solutions that are adapted to their circumstances.
 
Psychodynamic therapy is informed by developments in psychoanalytic thinking and has an intra-psychic focus, seeking to understand the influence of early experiences on our current patterns of relating and psychological functioning. Through seeking to understand the ways in which we respond to, and protect ourselves from, difficult emotional experiences, the influence of early relationship traumas can be examined and worked through in therapy. This often involves reflecting on what fears and feelings get expressed in the therapeutic relationship. The insight into these processes alongside safe experimentation with new ways of relating within the therapeutic relationship enables resolution.