How I work.
My clinical practice is based on interventions from a range of evidence-based therapeutic modalities. Each is adapted to the person, their history and their pace, within a trauma-informed framework.
The five approaches below are the ones I draw on most often. In practice they are rarely used in isolation: a course of therapy might begin with stabilisation and skills from CBT, move into trauma processing with EMDR or Cognitive Processing Therapy, and draw on Schema Therapy to understand the longer-standing patterns underneath. What matters is the fit between the approach, the person and the moment.
Cognitive-Behavioural Therapy (CBT)
CBT is a structured, evidence-based psychological therapy that examines the relationship between the way we think, the way we feel, and the way we act. It rests on a simple but powerful observation: it is rarely a situation itself that determines how we feel, but the meaning we attach to it. When those meanings become rigid, overly negative, or disconnected from the evidence, they can sustain cycles of low mood, anxiety, avoidance and self-criticism long after the original difficulty has passed.
In practice, CBT is a collaborative and active form of therapy. Together we map the patterns that keep a problem going, learn to notice unhelpful thoughts as they arise, and test them against the evidence rather than accepting them as fact. Behavioural strategies, such as gradually re-engaging with avoided activities or experimenting with new ways of responding, are used alongside this cognitive work. Between sessions, brief practice tasks help consolidate what has been learned, so that change takes place in daily life and not only in the therapy room.
CBT has one of the strongest evidence bases of any psychological therapy and is recommended in clinical guidelines for depression, anxiety disorders, panic, and a wide range of other presentations. Within this practice, CBT is delivered flexibly and adapted to each person, often alongside other approaches described on this page. My postgraduate training in cognitive-behavioural therapies informs much of my clinical work, while my research background keeps that work grounded in current evidence.
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy is a trauma-focused form of cognitive therapy developed specifically for post-traumatic stress disorder. It is built on the understanding that trauma often leaves people with rigid and painful beliefs about why the event happened, what it says about them, and what it means for their safety, trust in others, sense of control, self-worth and capacity for intimacy. These beliefs, sometimes called stuck points, keep the trauma alive in the present and prevent natural recovery.
CPT is typically delivered over around twelve sessions and follows a clear structure. The early sessions focus on understanding how trauma affects memory, emotion and thinking, and on identifying the beliefs that have become stuck. We then work systematically through those beliefs, examining them with curiosity rather than judgement and considering more balanced and accurate ways of understanding what happened. Later sessions address the broader themes that trauma tends to disrupt. Importantly, CPT does not require a person to repeatedly relive the traumatic event in detail; the emphasis is on meaning rather than on re-experiencing.
CPT is recognised as a first-line treatment for PTSD in major international clinical guidelines and has been shown to be effective across a wide range of trauma histories, including interpersonal violence and abuse. Within this practice, CPT is offered within a trauma-informed framework, with careful attention to readiness, pacing and stabilisation, so that the work proceeds at a pace that feels safe and manageable.
Schema Therapy
Schema Therapy is an integrative approach that brings together cognitive, behavioural, experiential and relational methods to address long-standing patterns that often have their roots in childhood and adolescence. When core emotional needs, such as safety, connection, autonomy, self-expression and reasonable limits, are not adequately met early in life, we can develop deeply held beliefs and emotional responses about ourselves and others. These are called early maladaptive schemas, and they tend to repeat across relationships and life situations, often without our awareness.
In Schema Therapy we work to identify the schemas and coping styles that are shaping a person's life, understand where they came from, and gradually weaken their hold. This involves cognitive work, but it also involves experiential techniques such as imagery and chair work, and a therapeutic relationship that itself offers a corrective emotional experience. The aim is not only to change thinking, but to help people meet their own needs in healthier ways and respond to themselves with greater compassion.
Schema Therapy is particularly well suited to difficulties that have not responded fully to shorter-term approaches, including persistent relationship patterns, chronic feelings of emptiness or self-criticism, and the aftermath of emotionally abusive relationships. Within this practice, it is frequently drawn upon in work with complex trauma and with people recovering from narcissistic abuse, where understanding the origin of a pattern is often the first step toward changing it.
Prolonged Exposure Therapy
Prolonged Exposure is a trauma-focused cognitive-behavioural therapy for PTSD with several decades of research behind it. It is based on the understanding that avoidance, although entirely natural after trauma, is one of the main reasons symptoms persist. When memories, places, people or situations that remind us of the trauma are consistently avoided, the mind never has the opportunity to learn that the memory itself is not dangerous and that the present is different from the past.
Prolonged Exposure involves two main components, introduced gradually and always with the person's consent. Imaginal exposure involves revisiting the memory of the traumatic event in a safe, structured way within the session, followed by time to process what came up. In vivo exposure involves approaching, step by step, the situations in everyday life that have been avoided because they feel unsafe, even though they are not. Psychoeducation and breathing strategies support this work. Over time, distress associated with the memory reduces, and the person regains access to parts of their life that trauma had closed off.
Prolonged Exposure is a first-line treatment for PTSD in international guidelines and has demonstrated large and lasting reductions in symptoms. It is demanding work, and it is not the right starting point for everyone. Within this practice, exposure-based approaches are only introduced once a sense of safety and adequate coping resources are in place, and the pace is always guided by the individual. Where a more gradual or less direct approach is preferable, other methods described here may be used first or instead.
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a structured, evidence-based psychotherapy developed for the treatment of trauma and other distressing life experiences. It is grounded in the understanding that when an experience is overwhelming, the brain may not process it in the usual way. The memory can remain stored with the original images, emotions, body sensations and beliefs attached, so that it continues to be triggered in the present as if the event were still happening.
In EMDR, the person briefly brings a memory to mind while engaging in bilateral stimulation, most commonly guided eye movements. This appears to support the brain's natural information-processing system, allowing the memory to be reprocessed and integrated so that it becomes a part of the past rather than an ongoing source of distress. EMDR follows an eight-phase protocol with a strong emphasis on preparation and stabilisation before any trauma processing begins, and it does not require the person to describe the event in detail.
EMDR is recommended for PTSD by the World Health Organization and by leading clinical guidelines, and research supports its use for a range of difficulties in which adverse experiences play a role, including complex trauma, anxiety, depression and grief. Within this practice, EMDR is delivered within a trauma-informed framework and integrated with the other approaches described on this page where appropriate. You can read more in my article on what EMDR is and how it can help. What is EMDR and how can it help?
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