Other Therapies and Approaches
We have looked at the four main psychological therapy categories but there are a number of other therapies that do not quite fit any of those four. Elements and techniques may be utilised from them but they cannot be slotted neatly into any of those four.
Other Therapies: Eye movement desensitisation and reprocessing (EMDR)
Eye movement desensitisation and reprocessing (EMDR) is a psychotherapy developed by Francine Shapiro that emphasizes disturbing memories as the cause of psychopathology. It is used to help with the symptoms of post traumatic stress disorder (PTSD). According to Shapiro, when a traumatic or distressing experience occurs, it may overwhelm normal coping mechanisms. The memory and associated stimuli are inadequately processed and stored in an isolated memory network.
The goal of EMDR is to reduce the long-lasting effects of distressing memories by developing more adaptive coping mechanisms. The therapy uses an eight-phase approach that includes having the patient recall distressing images while receiving one of several types of bilateral sensory input, such as side to side eye movements. EMDR was originally developed to treat adults with PTSD; however, it is also used to treat other conditions and children.
Although controlled research has concentrated on the application of EMDR to PTSD, a number of studies have investigated EMDR therapy’s efficacy with other disorders, such as borderline personality disorder, and somatic disorders such as phantom limb pain.
EMDR has been used effectively in the treatment of children who have experienced trauma and complex trauma. EMDR is often cited as a component in the treatment of complex post-traumatic stress disorder.
EMDR therapy consists of eight phases and each phase has its precise intentions.
Phase I History and Treatment Planning
The therapist conducts an initial evaluation of the client’s history and develops a general plan for treatment. This includes the problems which are the primary complaint of the client and a history of distressing memories which will become the targets for reprocessing.
Phase II Preparation
The therapist helps the client develop ways to cope with distressing emotions so that they are able to calm down and help themselves in between therapy sessions. Commonly this is done with guided imagery or other relaxation techniques.
Phase III Assessment
The therapist asks the client to visualise an image that represents the disturbing event. Along with it, the client describes a thought or negative cognition (NC) associated with the image. The client is asked to develop a positive cognition (PC) to be associated with the same image that is desired in place of the negative one. The client is asked how strongly he or she believes the PCs to be true using a 1-7 scale (completely false to completely true) called the Validity of Cognition (VOC) scale. The client is also asked to identify what emotions he or she feels. The client is then asked to rate his or her level of distress on a scale from 0-10, with 0 being no distress and 10 being the most distress they can imagine. This is the same as a Subjective Units of Distress scale (SUD) that is commonly used in cognitive behavioural therapy (CBT). Finally the client is asked to identify where in the body he or she is sensing the feelings.
Phase IV Desensitisation
During the reprocessing phases of EMDR therapy, the client focuses on the disturbing memory in multiple brief sets of about 15–30 seconds. Simultaneously, the client focuses on the dual attention stimulus, which consists of focusing on the trauma while the clinician initiates lateral eye movement or another stimulus such as a pulsing light held in each hand, or tapping on the knees. Following each set, the client is asked what associative information was elicited during the procedure. This new material usually becomes the focus of the next set or another aspect of the memory may be guided by the clinician. This process of personal association is repeated many times during the session. This process continues until the client no longer feels as distressed when thinking of the target memory.
Phase V Installation
The therapist asks the client to focus on the event along with the PC developed in phase III. The client is asked to hold in mind the memory with the positive thought as the therapist continues with the bilateral stimulation. When the client feels he or she is certain the PC is fully believed and that belief is as strong as possible, the installation phase is complete.
Phase VI Body Scan
At this phase the goal of the therapist is to identify any uncomfortable sensations that could be lingering in the body when thinking about the target memory and the PC. While thinking about the event and the positive belief the client is asked to scan over his or her body entirely, searching for tension, tightness or other unusual physical sensation. Any negative sensations are targeted and then diminished, using the same bilateral stimulation technique from phases IV and V. The PCs should be incorporated emotionally as well as intellectually. Phase VI is complete when the client is able to think and speak about the event along with the PC without feeling any physical or emotional discomfort.
Phase VII Closure
Not all traumatic events will be resolved completely within one session. If the client is significantly distressed the therapist will guide the client through relaxation techniques that are designed to bring about emotional stability and tranquillity. The client will also be asked to use these same techniques for experiences that might arise between sessions such as strong emotions, unwanted imagery, and negative thoughts. The client may be encouraged to keep a brief log of these experiences, allowing for easy recall and processing during the next session.
Phase VIII Revaluation
With every new session, the therapist will revaluate the work done in the prior session. The therapist will also assess how well the client managed on his or her own in between visits. At this point, the therapist will decide whether it is best to continue working on previous targets or continue to newer ones.
Download a detailed pdf about EMDR
The EMDR Association is the main professional body for therapists in the UK.
Other Therapies: Family and Systemic Psychotherapy
Family Therapy is an approach that works with families and those in close relationships to create positive change. The changes are seen in terms of the systems of interaction between each person in the relationship.
These relationships are known as systems.
Family therapy enables family members and others who care about each other in a relationship to explore their difficulties safely.
They have a chance to:
understand each other’s experiences
understand each other’s views
appreciate each other’s needs
reflect on important relationships
build on strengths – their own and each others
find better ways forward
make beneficial changes in their relationships and their lives
Research has shown that Family Therapy is very useful for children and young people who are experiencing difficulties in a relationship.
Family Therapy aims are:
To be inclusive and consider the needs of every member of the family or relationships
To adapt the way of working according to people’s ages, needs, resources and preferences
To acknowledge and build on the strengths and resources of the people concerned
To be in partnership with families
To be accepting of diverse family types and relationships
To be impartial and give all people in the family/relationship to talk equally; either together or individually
To be non-judgemental and aim not to take sides or blame an individual
Aim to engage people in sharing views with each other, develop new understandings and exploring better behaviour that work for them
Will not provide simple ‘one size fits all’ answers
Sessions with a Family Therapist usually last between 50-90 minutes, depending on client needs.
Sessions involving children may include play and drawing. People may wish to talk together from the start of the sessions. Some people need 1-2-1 time with the Family Therapist to begin with.
Family Therapists work as individuals or a member of a team. Sometimes other team member sit behind a one-way mirror or watch by CCTV.
Research shows Family Therapy is useful for a wide range of difficulties and circumstances including:
Couple relationship problems
Child and adolescent ‘growing up’ issues
Adult mental health problems
Child, adolescent and adult behavioural difficulties
Serious illness or disability of the family member
Separation, divorce, death
Step-family relationship issues
Family member with an eating disorder
Fostering, adoption and fulfilling needs of ‘looked after’ children
Violence and abuse in the home
Drug and alcohol misuse
The effects of trauma – mental and physical
Difficulties related to old age and
Difficulties due to other life cycle changes
Professionals with ‘systemic family therapy’ trainings can be found working with families and other caring relationships in social care, schools, hospitals, hospices, organisational consultancies, substance misuse services, older adults services, youth offending projects, community outreach projects and more.
Download a detailed pdf about Family Therapy
The Institute of Family Therapy is the leading organisation for therapists in the UK
Other Therapies: Couples counselling
What is couples counselling?
Couples counselling (used to be called marriage guidance) looks how two people in a relationship communicate and then helps to resolve any negative issues.
All couples counsellors are well trained specialists in this area. However; there are no legal regulations on what level of training a couples counsellor needs. At ACCPH we require diploma qualification of no less than Level 3 (or equivalent) in couples counselling. So you will be able to have peace of mind that your counsellor has the required knowledge and skills to help you.
Couples counselling is about the two persons attending the sessions together. But initially one of them may be reluctant to speak to a couples counsellor. So it is OK for just one person to begin on their own. The partner will often join in after they have started to see changes in the other person. Many couples counsellor will intersperse couple sessions with individual ones.
Clients will also be asked to carry out ‘homework’. Such as do a particular task or discuss a specific thing with their partner. In the next session this will be talked about and outcomes discussed.
Couples counselling is not about the clients being told what to do. A couples counsellor should not offer their personal opinion; clients will not be told whether they are right or wrong in their beliefs and behaviours. They will not suggest that clients should separate or take sides with one party or the other. A couples counsellor is to facilitate changes by helping both partners communicate better and reach their own conclusions and resolutions.
How can couples counselling help?
When people in an intimate relationship or marriage they sometimes end up not listening properly to their partner and often do not express their own needs and desires clearly as they might offend the other person. The couple can lose all perspective of the requirements of their partner. Couples counselling provides a safe place to speak with the guidance of a trained professional.
The counsellor will help by providing sound psychological reasons behind emotions, behaviours and thoughts. This usually helps clients to understand why they are doing something that is destructive and this in turn can help them to create a more positive outcome.
The main drives of couples counselling is to:
Create understanding in how external factors affect their relationship: such as, lifestyle, family values, religion and culture.
Help clients to reflect on the past and how it affects them now.
Teach clients to communicate better and use it for positive construction not destruction of the relationship.
Understand how and why arguments escalate out of proportion
Help clients to learn how to negotiate and resolve conflicts
The most common relationship problems explored in couples counselling
There are many different concerns that may bring you to couples counselling, ranging from a lack of communication right through to a betrayal or affair.
Some common issues that can be explored through couples counselling include:
lack of trust due to any factor
betrayal or love affair
jealousy and envy
lack of communication in one or more areas
stress; work-related or due to family issues
different sexual needs or other sexual issues
different goals, values, standards, etc
different parenting styles
controlling behaviour or obsessive actions
Life changes, hormonal, retirement, redundancy, and many other factors
This list is far from exhaustive and every couples situation is unique to them.
When is the right time to seek help?
For most people couples counselling is the ‘last resort’ to save the relationship or marriage. However; it is far better to use therapy sessions as a way to keep the relationship healthy and sort out any underlying problems or cracks that could become major problems down the line.
Download a detailed pdf about Couples Counselling
is the main professional body for therapists working in this area of counselling.
Other Therapies: Group therapy
This type of therapy takes place with a group of people going through similar difficulties and is facilitated by one or more therapists.
Group therapy or group psychotherapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group as they are going through similar difficulties. Group therapy can offer emotional support and help develop interpersonal skills.
The term can refer to any form of psychotherapy when delivered in a group format. But it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilised as a mechanism of change. This is achieved by exploring and examining interpersonal relationships within the group. These are then developed to allow growth of the individual members.
Group therapy can include other approaches such as Cognitive behavioural therapy or Interpersonal therapy. So in broader terms group therapy can include any helping process within the group, such as anger management, mindfulness, relaxation training or social skills training and psycho-education groups. There are differences between how psychodynamic, activity, support, problem-solving and psycho-educational groups operate.
More specialised forms of group therapy would include non-verbal expressive therapies such as art therapy, dance therapy, or music therapy.
The following therapeutic factors are the basis of all group therapy:
Universality – The recognition of shared experiences and feelings among group members and that these may be widespread or universal human concerns, serves to remove a group member’s sense of isolation, validate their experiences, and raise self-esteem
Altruism – The group is a place where members can help each other, and the experience of being able to give something to another person can lift the member’s self esteem and help develop more adaptive coping styles and interpersonal skills.
Instillation of hope – In a mixed group that has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems with which they are still struggling.
Imparting information – While this is not strictly speaking a psychotherapeutic process, members often report that it has been very helpful to learn factual information from other members in the group. For example, about their treatment or about access to services.
Corrective recapitulation of the primary family experience – Members often unconsciously identify the group therapist and other group members with their own parents and siblings in a process that is a form of transference specific to group psychotherapy. The therapist’s interpretations can help group members gain understanding of the impact of childhood experiences on their personality, and they may learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships.
Development of socialising techniques – The group setting provides a safe and supportive environment for members to take risks by extending their repertoire of interpersonal behaviour and improving their social skills
Imitative behaviour – One way in which group members can develop social skills is through a modelling process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others.
Cohesiveness – It has been suggested that this is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation.
Existential factors – Learning that one has to take responsibility for one’s own life and the consequences of one’s decisions.
Catharsis – Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt.
Interpersonal learning – Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member’s behaviour and impact on others.
Self-understanding – This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one’s problems and the unconscious motivations that underlie one’s behaviour.
Download a detailed pdf about Group Therapy
Other Therapies: Interpersonal therapy (IPT)
With a focus on interpersonal relationships, this therapy examines the way we relate and how this impacts our mental well-being.
IPT is a time-limited and structured psychotherapy for moderate to severe depression. It is usually between 12-16 weeks. It is based on the concept that psychological symptoms, such as a low mood, is a response to current difficulties in the person’s everyday interactions with others. This can also affect the quality of their relationships.
E.G. Someone is depressed and withdraws from those close to them and refuses their help. (Let us say they feel a failure in life).
Family and friends feel rejected or hurt and cannot understand why their offers of help are refused. So they in turn pull away from the depressed person.
The depressed person takes this as confirmation that they are a failure, and they become more depressed and withdrawn. A vicious circle is in motion.
IPT focuses on difficulties in relating to others and helping the person to identify how they are feeling and behaving in their relationships. When a person is able to interact more effectively, their psychological symptoms often improve.
IPT typically focuses on the following relationship areas:
Conflict with another person: No relationship is perfect, but sometimes a significant relationship at home or at work can become very stuck in disagreements or arguments, and is a source of tension and distress.
Life changes that affect how you feel about yourself and others: Life changes all the time. As it does it throws up new challenges, such as when we have a child or lose a job. These changes, whether wished for or not, can leave us feeling unable to cope with the demands of the new situation and what is expected of us.
Grief and loss: It is natural to feel sad following the loss of a significant person in our life. Sometimes, however, it can be very difficult to adjust to life without that person and we may then put our life on hold, unable to carry on with our normal activities and with our relationships.
Difficulty in starting or keeping relationships going: Sometimes relationships are difficult because of what is missing, for example not having enough people around us or not feeling as close to others as we would like. Not having someone to turn to for company or support can be very stressful and can leave us feeling alone and overwhelmed by the demands of life.
At the start of therapy the IPT therapist will also ask the client to complete some questionnaires. These will give them a better idea of the sorts of problems they have, as well as how badly these affect the client.
The client will complete the questionnaires again during therapy on a weekly basis because this helps the client and therapist see what progress is being made. Not everyone makes progress at the same rate. These questionnaires help to monitor how the client’s symptoms are affected by what is happening in their relationships with others and how their symptoms affect these.
The therapist will also ask their client to think about the people in their life who may be able to provide support to help you overcome their current difficulties. Where appropriate they will help a client to develop new relationships that can provide the support they need.
Once a clearer picture of the relationships that are connected with the client’s symptoms is gained, they become the main areas that therapy will focus on. As IPT is time-limited, the client and therapist work out goals that are realistic.
E.G. Someone who fears that they will be rejected if they speak their mind set a goal to take the risk of trying out different ways of communicating more directly.
Six months after therapy has finished the therapist usually contacts the client to see how they are getting on.
Download a detailed pdf about Interpersonal Therapy
To read an article about IPT click
Other Therapies: Mindfulness
Mindfulness originated from Buddhist meditation that helps people focus on the present to gain greater awareness of their emotions and improve general well-being.
“Mindfulness is the awareness that emerges through paying attention on purpose, in the present moment. By cultivating mindful awareness, we discover how to live in the present moment rather than dwelling on the past or worrying about tomorrow”.
Mindfulness is an integrative, mind-body based technique that enables people to change the way they think and feel about their stressful experiences.
Mindfulness helps someone to pay attention to their thoughts, emotions and body sensations. It teaches them to become directly aware of them and manage them better.
It has deep roots in ancient Buddhist meditation practices but also draws on recent psychological and scientific advances. It can be of significant value for many people to help find peace in a frenetic world.
Neuroscience studies have found significant changes in those areas of the brain associated with decision-making, attention and empathy in people using Mindfulness meditation.
These studies have also shown that Mindfulness increases the size of the brain where regulating emotion occurs. It also improves people’s attention span so can help with performance, productivity and satisfaction in whatever is being undertaken.
It is already known that meditation increases blood flow to the brain, reduces blood pressure in the whole body and in doing reduces the risk of developing hypertension and cardiovascular disease.
People who have learned mindfulness tend to experience long-lasting physical and psychological stress reduction and develop positive changes in well-being. They are less likely to be depressed or get mental exhaustion. Many become able to control any addictive behaviours they had previously.
It sounds and is to many quite simple but for many people it is incredibly hard to learn. There are many ways to learn mindfulness but going to a good school is important. There are many therapist who have attended a 1 or 2 day workshop teach this to clients. ACCPH does not believe that is enough training and a client should look for someone with more in depth training and can actually do it them self; not just tell people what to do.
Download a detailed pdf about Mindfulness
This is a very useful link to find out more about
Other Therapies: Play therapy
Play Therapy helps children to understand their feelings and painful events they have experienced. It give them a chance and outlet to sort them out properly. Adults have the knowledge to be able to talk their problems through but cannot always explain what is troubling them so the use of play to communicate is used. They are able to work at their own level and pace, without feeling threatened.
As adults we understand that play is necessary for every child’s progression in the areas of social, emotional, cognitive, physical, creative and language development. Play therapy helps children for whom verbal communication is difficult.
During play therapy children receive strong emotional support so are able to learn and understand more about their own feelings and thoughts. Often they will re-enact traumatic life experiences or other difficulties to try to make sense of these and be able to cope better in the future. They can learn to control relationships or conflicts in more appropriate ways.
The concept is to see a reduction in anxieties and raised self-esteem by changes in thoughts and behaviour. This will lead to improved relationships within the family and with friends.
Play therapists receive extensive specialist training in subjects. They really understand child development and attachment processes. Play is a child’s natural form of expression, so play therapists are trained to use this as a way to understand and communicate with children about all their good and bad emotions, thoughts and behaviours.
A play therapist will review the history behind the child’s difficulties and find out about the stresses and problems within the family – past and present. They could get information from schools, G.P’s and other sources. An assessment will be made of the child’s strengths, not just their difficulties.
Play therapists may work as part of a team or independently. They and may recommend a referral for other intervention as part of the support for parents or other family members.
There is no fixed number of sessions. However, 12 would be seen as a short intervention but when problems have been persistent for a long time or are complex , intervention can take many months. Sessions are usually once a week at a set time, on the same day, in the same place. This is deemed as important for developing a trusting relationship with the child.
The child’s play therapist will meet with parents/care giver at regular intervals to discuss the child’s progress in therapy sessions and to ask about improvements at home.
Download a detailed pdf about Play Therapy
is the main professional body for play therapists in the UK. British Association of Play Therapists
Other Therapies: Psychosexual Therapy (PST)
Psychosexual therapy is talking therapy conducted by a highly qualified practitioner that specialises in helping individuals and couples who experience sexual difficulties. PST is a behavioural programme which candidly explores all sexual problems and looks at emotional, (psychological), blocks for the person or couple.
Most sexual problems are too personal to discuss with friends or family so a psychosexual therapist can provide the safe place where a client can freely explore issues that are very intimate.
Psychosexual therapy can help with:
Rapid (premature) ejaculation
Difficulty in female orgasm
Sexual arousal issues
Low sexual appetite
High sexual appetite
Painful intercourse (vaginal dryness)
Issues around intimacy
Sexual risk taking behaviour
The initial session is an assessment where the client and therapist decide whether psychosexual therapy likely to be helpful. The therapist will ask questions about their personal life, including things about their family, and the client’s medical and sexual histories to establish a fuller picture of the problem/s. The therapist will decide if psychosexual therapy could benefit the client a series of sessions will be offered.
Most psychosexual therapists follow an integrative/ holistic treatment model. This will often be based on a variety of therapeutic styles depending on requirements of the client.
Usually the treatment is short-term and may only need a few sessions.
Many psychosexual therapists ask the client to bring their partner to the therapy sessions. When this happens there is more likely to be a successful outcome.
Download a detailed pdf about Psychosexual Therapy
For further information visit the College of Sexual and Relationship Therapists