Our approach
No single model explains a whole person
This practice is integrative. That is not a way of avoiding the question of method — it is a considered position, and this page sets out what it means, which approaches are drawn on, and how the decision is made in your particular case.
Therapy has a long history of schools that were certain they were right. The research that followed has been humbling for all of them: when bona fide therapies are compared properly, the differences between them tend to be modest, while the things they share turn out to matter enormously. That finding does not make method irrelevant. It changes what method is for. An approach is a tool for a particular job, chosen after you understand the job — not a philosophy you sign up to in advance.
The common factor
The relationship is the strongest thing we have
If you took everything that has been learned about psychotherapy over the last half century and had to keep one finding, it would probably be this: the quality of the working relationship between client and therapist is the most consistent predictor of outcome that lies within a therapist’s control. It predicts better than the therapist’s theoretical school, and better than most of the techniques deployed inside it.
The technical term is the therapeutic alliance, and it has three ordinary parts. First, agreement on goals — you and the therapist actually want the same thing from this. If you came to decide whether to leave your marriage and the therapist is quietly working to save it, no technique will rescue that. Second, agreement on tasks — you accept that the things being asked of you are plausibly connected to what you want. Third, the bond: whether you feel understood, taken seriously, and not judged.
All three are checkable, and all three should be checked out loud rather than assumed. That is why you will be asked directly, more than once, whether the sessions are useful and whether the direction still feels right.
The alliance also breaks. Somebody feels misunderstood, or pushed too hard, or subtly criticised, and the atmosphere changes. These ruptures are entirely normal, and the research on them is encouraging in an unexpected way: repairing a rupture — naming it, taking it seriously, adjusting — is itself associated with good outcomes. A therapy where nothing ever goes slightly wrong is often a therapy where nothing much is being risked. What matters is what happens next.
There is a practical implication of all this. If, after a few sessions, you do not feel a working connection with your therapist, that is real information rather than a character flaw in either of you. Saying so is welcome here, and being helped to find a better fit is a legitimate outcome of a first block of sessions.
What this means for you in week one
You are allowed to interview a therapist. Reasonable questions at a first session include how they intend to work with your situation, what their training is, how progress will be judged, and what would make them refer you elsewhere. Anyone who treats those questions as a challenge is answering them.
Integration
Integrative, not improvised
Integration has a bad reputation in some quarters, and occasionally it is deserved: borrowing a technique because it came to mind is not integration, it is drift. Three rules keep it disciplined.
Formulation comes before method
No approach is selected until there is a shared account of what is keeping the difficulty going. The formulation is the thing being treated. Once it exists, the choice of method is usually fairly obvious — panic maintained by avoidance and safety behaviours points somewhere specific; a couple caught in a pursue-withdraw cycle points somewhere else entirely.
One frame at a time, named out loud
Approaches are not blended into a soup. Where the work moves from, say, behavioural experiments into something more exploratory, you will be told that it is moving and why. Knowing which frame you are in lets you evaluate whether it is working — and lets you object to it, which is the more important half.
Evidence first, preference second
Where there is a well-established approach for a specific difficulty, that is the starting proposal, and any departure from it needs a reason that can be stated. A therapist’s fondness for a model is not a reason. Your considered preference, on the other hand, is — because an approach you have no faith in is unlikely to work however well evidenced it is.
One more distinction worth having. Integration is not the same as offering everything to everyone. There are difficulties that need a specialist protocol delivered by somebody who does it week in, week out, and there are difficulties that need medical treatment before any talking therapy will hold. Knowing where that line sits is part of the method, and you can read where this practice draws it on the honest fit section of the about page.
Ways of working — individuals
The approaches drawn on for individual work
Each entry sets out what the approach is, what it tends to be useful for, and what an hour of it actually feels like from the client’s chair. Open whichever is relevant to you.
Cognitive Behavioural Therapy (CBT)
What it is
A structured, present-focused way of working with the links between a situation, the thoughts it triggers, the feelings and bodily sensations that follow, and what you then do. The central observation is that those four things maintain one another: avoiding a feared meeting lowers anxiety this afternoon and raises it next week. CBT works on that loop rather than on the distant past. It is the most extensively researched talking therapy, and NICE recommends it as a first-line psychological treatment for depression and for the anxiety disorders.
What it is useful for
Panic, generalised anxiety, social anxiety, health anxiety, phobias, obsessive-compulsive difficulties, depression and low mood, insomnia, and anger that has become a habit rather than a signal. It suits people who want structure and are willing to do something differently between sessions.
What a session actually feels like
Purposeful. Sessions usually start by agreeing what to spend the hour on, then look at a specific real example from the week in some detail — often written out on paper between us. You will be asked to test a belief rather than argue with it: making the phone call, staying in the supermarket, dropping the safety behaviour. That part is genuinely uncomfortable, and it is where most of the change happens. There is normally something to try before the next session, and it is agreed with you rather than set.
Acceptance and Commitment Therapy (ACT)
What it is
A development of the same broad tradition with a different premise. Rather than changing the content of difficult thoughts, ACT works on your relationship to them — noticing a thought as a thought rather than an instruction, making room for a feeling instead of fighting it, and then acting on what you actually value regardless of the noise. Its working parts are defusion, acceptance, contact with the present moment, a steadier sense of self, clarity about values, and committed action.
What it is useful for
Long-standing anxiety that has not shifted with argument, chronic pain and long-term health conditions, perfectionism, burnout, grief, and the particular kind of stuckness where you know what you think and nothing changes. It is also useful when a difficulty genuinely cannot be removed and life still has to be lived alongside it.
What a session actually feels like
More experiential and less analytical than CBT. Expect exercises rather than explanations: short attention practices, metaphors, sometimes standing up and physically arranging things in the room. A good deal of time goes on values — not goals, but the direction you want your life to point in — and then on very small concrete commitments in that direction. People often describe it as a relief to stop trying to win an argument with their own mind.
Person-centred practice
What it is
The tradition originating with Carl Rogers, and the foundation most UK counselling training is built on. Its claim is that people have their own capacity to move towards what is healthy for them, and that this capacity emerges reliably in the presence of three conditions: accurate empathy, unconditional positive regard, and a therapist who is genuine rather than playing a role. There is no technique to apply and no expert interpretation on offer.
What it is useful for
Bereavement and loss, identity and life-stage questions, shame and self-worth, and any situation where you have been advised, managed and instructed at by everybody and have not yet had the chance to hear your own thinking out loud. It also underpins everything else here — the other models are delivered inside this stance, not instead of it.
What a session actually feels like
Quieter than people expect, and occasionally disconcerting at first. The therapist follows rather than leads. Silences are allowed to sit. Nobody hands you a worksheet. If you arrive wanting to be told what to do, the early sessions can feel like too much freedom; most people find that within a few weeks the space stops feeling empty and starts feeling like the first room in a long time where nothing has to be performed.
Psychodynamic thinking
What it is
An approach interested in what sits outside immediate awareness: the templates for closeness and safety laid down early in life, the defences built to survive something, and the way both get re-enacted in present-day relationships without anyone intending it. It is not about blaming parents, and it does not require years on a couch. It is a way of asking why a pattern keeps arriving, in different people, with the same ending.
What it is useful for
Recurring relationship patterns, self-sabotage, difficulties that return after symptom-focused work has helped for a while, chronic low self-worth with no obvious cause, and the very common presentation of somebody who can explain their problem perfectly and cannot budge it.
What a session actually feels like
Less structured and slower. There is often no agenda: you start where you are and see where it goes. The therapist may notice something happening between the two of you in the room — a sudden change of subject, an apology, a joke at your own expense — and ask about it, because the pattern in the room is usually the pattern outside it. Connections between past and present are offered tentatively, as possibilities to test rather than verdicts. It asks for a tolerance of not knowing, and it rewards it.
Trauma-informed practice
What it is
Not a model but a stance that governs how every other model is delivered. It assumes that symptoms may be adaptations that once made sense, and it organises the work around safety, choice, collaboration and pace. Practically, that means stabilisation and grounding come before anything else, you are never required to give a detailed account of what happened in order to be helped, and the work stays inside the range where you can think and feel at the same time rather than becoming overwhelmed or shut down.
What it is useful for
Anyone with a history of abuse, neglect, violence, a frightening medical event, an accident, or the accumulated effect of a childhood spent managing an unpredictable adult. It is also relevant for people who would never use the word trauma about themselves and who nonetheless flinch, freeze or disappear under pressure.
What a session actually feels like
Deliberately unhurried, with a lot of checking. You will be asked what you notice in your body, and offered ways to slow down, pause, or stop entirely — and taking them is treated as a skill, not a failure. For post-traumatic stress specifically, NICE recommends trauma-focused CBT and EMDR; where a structured protocol of that kind is indicated we will discuss it openly, and where it is not something offered here we will help you find a practitioner who provides it rather than approximating it.
The question is never which therapy is best. It is what is keeping this particular difficulty alive, for this particular person, and what is most likely to interrupt it.
Ways of working — couples and families
When the difficulty lives between people
Relational work follows a different logic to individual work. There is no single client whose account is definitive, no version of events that is simply true, and no useful role for a therapist who is adjudicating. The unit of attention is the pattern between people, which is why sessions can feel disorientating for anyone who arrived hoping to be found right.
Two established couples approaches inform most of the work here, alongside systemic family thinking. They are compatible and are often used in sequence rather than chosen between: structure and skills where communication has broken down, attachment work where the distance has become the problem.
Emotionally Focused Therapy (EFT) for couples
What it is
An established couples approach grounded in attachment theory. Its core idea is that distressed couples become caught in a negative cycle — most commonly one partner pursues and protests while the other withdraws and shuts down — and that the cycle, not either person, is the problem. Underneath the surface argument sit attachment questions: are you there for me, do I matter to you, will you come if I call. The work is to slow the cycle down, make those questions speakable, and rebuild the sequence so that reaching for one another becomes possible again.
What it is useful for
Couples who keep having the same fight in different costumes, emotional distance, a partner who has gone quiet, recovery after an affair or a breach of trust, and relationships strained by illness, new parenthood or bereavement. It is also useful when both people still care and neither can find the way back in.
What a session actually feels like
Slower than expected, and more emotional. The therapist will interrupt — often mid-sentence — to hold a moment still and ask what just happened, what you noticed in your body, what you were afraid of in that second. Much of the talking is directed to your partner rather than to the therapist. Couples frequently say the first sessions are the first time they have heard what the other person was actually feeling under the complaint.
The Gottman Method for couples
What it is
An established couples approach built on decades of observational research into how partners actually behave with one another. It is more structured and more educational than EFT. Its well-known contributions include the four corrosive communication habits — criticism, contempt, defensiveness and stonewalling — the importance of small bids for connection and whether they are turned towards or away from, the role of repair attempts during conflict, and the distinction between solvable problems and perpetual ones. Most conflict in long relationships is perpetual, which reframes the goal from resolution to dialogue.
What it is useful for
Couples who communicate badly rather than feel little, high-conflict escalation, contempt that has crept in, friendship that has eroded under logistics and children, and pairs who want practical structure and something to practise between sessions.
What a session actually feels like
Organised. There is usually a proper assessment phase — a joint session, a session with each partner individually, and sometimes questionnaires — followed by feedback on what the pattern is. After that, sessions mix conversation with specific exercises: a structured way to raise a complaint without criticism, a listening turn nobody is allowed to interrupt, a weekly ritual for reconnection. Some couples find the exercises artificial for a fortnight and then stop noticing they are doing them.
Systemic and family systems thinking
What it is
Family therapy works with patterns of interaction rather than with one identified patient. Where a linear view says the teenager is the problem, a systemic view asks what the whole family is organised around, what each person does in response to each other, and what the behaviour might be solving for the system as a whole. Causality is treated as circular: everybody is responding to everybody. Practically this brings in genograms, circular questions that ask one person what they imagine another feels, reframing, externalising the problem so it stops being a person, and careful attention to exceptions when the pattern does not happen.
What it is useful for
Adolescents in difficulty, parenting disagreements, separation and co-parenting, blended families, illness or disability affecting the whole household, estrangement between generations, and the situation where one family member has been quietly designated as the one with the problem.
What a session actually feels like
Unusual at first. Several people are in the room and the therapist may ask each of you what you think somebody else is thinking, which is disarming and productive in roughly equal measure. Nobody is prosecuted. Sessions are often longer or spaced further apart than individual work, because families need time between meetings for a small change to take hold. It can also be done with one person: a single family member changing their part of a pattern shifts the pattern.
Solution-focused work and coaching frameworks
What it is
Solution-focused brief therapy starts from an unusual place: rather than analysing the problem, it studies the times the problem is absent or smaller, on the basis that useful change is already happening somewhere and can be amplified. Its tools are exceptions, scaling questions, and a very concrete description of what the first small sign of improvement would look like. Coaching frameworks such as GROW — goal, reality, options, will — share that forward orientation and add explicit accountability. Coaching assumes you are resourceful and stuck on a decision or a habit, not that you are unwell.
What it is useful for
Direction and decisions, confidence, boundaries at work and at home, procrastination, career transitions, and momentum after a difficult period has passed. It suits people who are functioning reasonably well and want traction rather than exploration.
What a session actually feels like
Brisk, practical and forward-facing. Sessions circle around what you want to be different, what has already worked even slightly, and what the next smallest workable step is. Progress is often tracked out loud on a simple scale, and there is normally something specific to do afterwards. Coaching is not therapy and is not treatment: if it becomes clear that a coaching enquiry is really depression, grief or an unaddressed trauma, we will say so and change register. The distinction is set out in full on the life coaching page.
Assessment
How a plan gets made, and how it gets changed
Nobody should be several months into a piece of work without a clear answer to the question of what it is for. This is the sequence, and it is the same whether you come alone, as a couple or as a family.
A short conversation before anything is booked
The first contact is short and carries no obligation. You describe roughly what is going on; we describe what working here would involve, what it costs and when appointments are available. The purpose is to establish whether this is worth a first session at all. If a different kind of help would serve you better — NHS talking therapies, a psychiatrist, a specialist service, a solicitor, a debt adviser — this is the point at which it is most useful to say so.
A first session that maps rather than treats
The first full session is mostly listening and mapping. What brought you now rather than a year ago. What has already been tried, including what helped. What a normal week looks like. Relevant history, health and medication. Alcohol, sleep and anything else that is holding the difficulty in place. Safety, asked directly and without alarm. And, importantly, what you would want to be different — described concretely enough that both of us would recognise it if it happened.
A shared formulation, in your words
A formulation is simply a working explanation of what started the difficulty and, more importantly, what is keeping it going now. It is written in your language, not clinical language, and it is offered as a draft to be corrected. A good formulation should feel like a relief — the moment where a mess becomes a mechanism. It is provisional by design and gets revised as we learn more.
Agreeing the method, the frequency and the frame
Only now does the question of approach arise, and it is answered together: which way of working fits this formulation and this person, how often to meet, roughly how long we expect the work to take, what happens between sessions, and what the practical terms are. You will be told what is being proposed and why, in enough detail to disagree with it.
Deliberate reviews, in the diary from the start
A review is booked from the outset — typically after the first six to eight sessions, and periodically after that. It is a proper conversation with three questions: what has actually changed, what has not, and whether continuing in this direction is justified. A review is also the safest place to say that something is not working, because it has been scheduled rather than triggered by a crisis of confidence.
What a formulation is not
It is not a diagnosis, and it does not label you. Diagnosis is a medical act performed by a doctor; a formulation is a shared working explanation, owned by both of us, and thrown away the moment it stops fitting the evidence of your life.
Between sessions
Most approaches here involve something small between appointments — a record, an experiment, a conversation, a practice. It is always agreed rather than assigned, and if it did not happen that is worth discussing rather than apologising for. Very often the reason it did not happen is the most useful thing available.
Progress
What getting better actually looks like, and why it is rarely a line
Improvement in therapy is real and it is measurable, but it seldom arrives in the shape people expect. Knowing the shape in advance stops a normal dip being read as failure.
The signs worth watching
Symptom reduction matters — fewer panic attacks, better sleep, a mood that lifts. But the earliest and most reliable signs of change tend to be less dramatic than that, and they are easy to miss if nobody names them beforehand.
- You recover from a bad day in hours rather than days.
- You notice the pattern while it is happening, not a week later.
- An argument still starts but it repairs, and it repairs sooner.
- You do something you had been avoiding, and it costs less than you predicted.
- The internal commentary gets quieter, or at least less persuasive.
- Other people notice before you do.
- You find you have less to say in sessions, because less is happening.
How it is tracked
Mostly by asking, every few weeks, in ordinary language: what is different, what is the same, what is worse. Where you find them useful, brief standard questionnaires of the kind used across NHS talking therapies can be added — they are quick, they make small changes visible, and they are entirely optional. Some people find them clarifying; others find them reductive. Both responses are fine.
The shapes that progress usually takes
Relief, then a dip
The first few sessions often bring genuine relief simply from having said the thing out loud. When that settles, week five or six can feel flat. It is not a relapse; it is the point at which the actual work starts.
Worse before better
If avoidance has been holding anxiety down, deliberately stopping the avoidance raises distress in the short term by design. Approaching what you have been steering around is uncomfortable and it is the mechanism, not a side effect.
The plateau that is really consolidation
Long flat stretches where nothing seems to move are common, and are frequently the period in which a new way of responding is quietly becoming automatic. Worth reviewing, not worth panicking about.
The setback with a date on it
Anniversaries, court dates, a birthday, the first Christmas. A dip attached to a specific event is different from a general decline, and it is usually shorter than it feels.
And if it genuinely is not working
If a fair trial of an approach has produced no meaningful movement, that will be said plainly at a review rather than absorbed quietly. The options are then to change the method, change the frequency, bring in another kind of help, refer you to someone better suited, or stop. Continuing unchanged because the appointment already exists is not one of them.
Endings
Finishing well is part of the treatment
Endings in therapy are often handled badly, and it matters more than it sounds. For a great many people, the significant endings in their life have been abrupt, unexplained or entirely one-sided. An ending that is discussed in advance, shaped together and completed properly is therefore not administration. It is frequently the most useful piece of work in the whole course.
A planned ending
Where possible, the last few sessions are known to be the last few sessions. That time is used deliberately: reviewing what has actually changed and what has not, putting words to how it changed so it is repeatable, identifying the early warning signs that would suggest things are slipping, and writing down what to do about them. Many people taper rather than stop — fortnightly for a while, then monthly — which tests the change under real conditions while support is still available.
An unplanned ending
Sometimes people simply stop coming. Money changes, work changes, the crisis passes, or something in the room did not sit right and it felt easier to disappear than to say so. You will not be chased or made to feel you owe an explanation. You are welcome to send a single line saying you are stopping, and more welcome still to come back for one session to end it properly — that session is often surprisingly valuable, and it is genuinely fine to book it months later.
Coming back
Returning is not a failure and it is not a relapse of character. Life produces new material: a bereavement, a redundancy, a child leaving, a diagnosis. Plenty of people return for a short block of a few sessions and find that the earlier work makes the second course much quicker. The door stays open, and previous clients do not go back to the beginning.
Before you decide
Questions people ask about the way we work
If yours is not here, the full list is on the FAQ page, and anything else can be asked at the first contact.
Do I have to choose an approach before I start?
No, and it is usually a mistake to try. The choice of approach follows the assessment and the shared formulation, not the other way round. If you already know that a particular way of working has helped you before, say so at the first contact — that is genuinely useful information and it will shape what is proposed.
How many sessions will I need?
Honestly, it depends on what you are bringing and it cannot be known at the outset. Focused work on a specific, recent difficulty is often shorter than work on a pattern that has been running for decades. What we can commit to is naming an expected range at the point the plan is agreed, reviewing it openly, and never encouraging sessions to continue past the point of usefulness.
Will I have to talk about my childhood?
Only if it turns out to be relevant, and only at a pace you set. Some approaches here barely touch it. Others find that a present-day pattern makes far more sense in the light of an earlier one. You are never required to give a detailed account of anything, particularly anything traumatic, in order to be helped.
Is online therapy as effective as meeting in person?
For many common difficulties, research broadly supports online talking therapy as a comparable option, and a great many people find it works well. It is not right for everyone or for every situation: significant risk, a home with no private space, and family work with younger children are all better served in the room. We will give you a straight view on which is likely to suit your situation.
What happens if I do not like the way we are working?
Say so. It is not rudeness and it is not a setback — disagreement about the method is legitimate material for a session and often the most useful thing said all month. The approach can be changed, the pace can be changed, and if the fit is genuinely wrong we will help you find someone else rather than persuade you to stay.
Not sure which of these applies to you?
That is the normal position, and it is not something to resolve on your own before getting in touch. Describe the situation in a few sentences and we will tell you what we would suggest and why. Enquiries are usually answered within one working day.
This is a planned, appointment-based practice rather than a crisis service, and nobody monitors the phone or the inbox out of hours. If you need support sooner than an appointment, the free national services on our urgent help page answer at any hour.