How I work
Therapeutic approaches
Clinical psychologists train in several therapies rather than one, and the point of that training isn't to offer a menu. It's to be able to match the approach to the person.
So the honest answer to "which therapy do you do" is that it depends on what the assessment finds. Someone whose difficulty is maintained by a clear, current cycle needs something different from someone whose difficulty has been running since childhood. Both can be helped; they need different tools.
What follows is what those tools are, and roughly who each one suits. You don't need to arrive knowing which you want — working that out is part of what assessment is for.
CBT
Cognitive behavioural therapy (CBT)
The most extensively researched psychological therapy, and the first-line recommendation for a wide range of difficulties including anxiety, panic, OCD, health anxiety and depression.
CBT works on the relationship between what you think, what you do and how you feel — specifically on the cycles where those three reinforce each other. Avoiding something because it feels dangerous means never learning that it isn't; checking something for reassurance means the doubt returns stronger. CBT identifies those loops and works to interrupt them.
It's structured, active and time-limited. Most of the change happens between sessions rather than in them, which some people find refreshing and others find demanding.
Suits: anxiety, panic, OCD, phobias, depression, health anxiety.
CBT-E
CBT-E — enhanced cognitive behavioural therapy
The version developed specifically for eating disorders, and the first-line evidence-based treatment for adults. It's not standard CBT with food added; it's a distinct protocol built around the mechanisms that keep eating disorders running.
CBT-E works across diagnoses rather than treating anorexia, bulimia and binge eating disorder as separate problems needing separate treatments — an approach that reflects how much these presentations share underneath.
Suits: anorexia nervosa, bulimia nervosa, binge eating disorder, OSFED.
CBT-AR
CBT-AR — for avoidant and restrictive eating
The adaptation developed for ARFID, addressing the three drivers that maintain restrictive eating: sensory avoidance, fear of aversive consequences such as choking or vomiting, and low interest in eating.
Treatment is gradual and collaborative, working on widening the range of foods you can rely on rather than pushing you toward things that frighten you. Progress is measured in range, not volume.
Suits: ARFID, long-standing safe-food patterns, sensory-based food avoidance.
IPT
Interpersonal psychotherapy (IPT)
IPT starts from the observation that psychological difficulty and relationships tend to move together — that depression often follows a loss, a role change, a conflict, or a period of isolation, and that working on the relational context shifts the mood rather than the other way around.
It's time-limited and focused on the present rather than on early history. Where CBT works on thoughts, IPT works on what's happening between you and the people around you.
Suits: depression, difficulty after bereavement, life transitions, relationship conflict.
Schema Therapy
Schema Therapy
Where a difficulty has been running since long before the current episode, shorter-term approaches sometimes reach their limit. Schema Therapy is built for that situation.
It works with long-standing patterns — the beliefs about yourself and others that formed early, made sense at the time, and now operate automatically in circumstances they no longer fit. It's a longer piece of work than CBT and goes deeper, drawing on cognitive, experiential and relational techniques.
Suits: long-standing patterns, recurrent difficulties, eating disorders that haven't responded to standard treatment, difficulties with self-worth.
CFT
Compassion-focused therapy (CFT)
Developed for people whose difficulties are driven substantially by shame and self-criticism — where you can know a thought is unreasonable and still feel the weight of it.
CFT works on building a genuinely different internal stance, rather than arguing with the critical one. That distinction matters, because for a lot of people the critical voice has been in place long enough that arguing with it is just another form of engagement.
It's frequently the approach that does most of the work in eating disorders and weight-related distress, where shame usually isn't a side effect but an engine.
Suits: shame, self-criticism, eating disorders, weight-related distress, difficulties following trauma.
EMDR
EMDR
Eye movement desensitisation and reprocessing, developed for trauma and recommended by NICE for PTSD.
It works on memories that haven't been processed normally — that remain vivid, intrusive and physically present in a way ordinary memories aren't. EMDR uses bilateral stimulation while the memory is held in mind, which appears to allow the brain to process material that has been stuck.
It doesn't require you to describe what happened in detail, which for some people is the difference between being able to do trauma work and not.
Suits: PTSD, single-incident trauma, complex trauma, distressing memories.
Choosing
How the approach gets chosen
At assessment, and with you rather than for you.
By the end of assessment you should understand what's maintaining the difficulty and why a particular approach follows from that. If something isn't working, we change it — that's a normal part of the work rather than a failure of it.
Every piece of work starts with understanding, not a label.
About the author
Dr Rachel Megahy
Chartered Clinical Psychologist since 2006, registered with the HCPC and chartered with the British Psychological Society. Specialist expertise in eating disorders, alongside therapy for anxiety, trauma and other psychological difficulties. Online across the UK.
Get in touch
A few lines about what's going on is enough. I'll reply personally within three working days.