Is person-centred counselling effective? Does person-centred therapy work?

Yes. Person-centred therapy has a well-established evidence base. A major 2021 randomised controlled trial — the PRaCTICED trial, published in The Lancet Psychiatry — found person-centred experiential therapy to be equally effective as CBT for moderate to severe depression within the NHS. It is the second most-delivered individual therapy in NHS Talking Therapies. Research by Mick Cooper and others also indicates that the more active, process-guiding forms of person-centred therapy perform on a par with other established therapies.

How is person-centred therapy different from CBT?

CBT is primarily technique-driven: it works with specific thought patterns and behaviours, uses structured exercises, and typically involves homework between sessions. Person-centred therapy focuses on the quality of the therapeutic relationship itself rather than technique. There is no fixed agenda; sessions follow the client's own concerns. Both approaches have strong evidence behind them, but the experience of the two feels quite different — CBT is more structured and directive, person-centred is more open and relational.

How long does psychodynamic therapy take?

Psychodynamic therapy is generally longer-term than approaches like CBT. While short-term psychodynamic therapy (typically 16–30 sessions) is available and has a good evidence base, many people engage in psychodynamic work over months or years. This is because the approach focuses on understanding deep-rooted patterns rather than managing specific symptoms, which tends to require more time. Sessions are usually weekly, sometimes twice weekly.

What does an integrative therapist do?

An integrative therapist draws on more than one therapeutic approach, tailoring their work to the individual client rather than following a fixed model. In practice, this might mean using the warm, non-directive relationship of person-centred therapy as a foundation, while also drawing on psychodynamic ideas about patterns from the past, or more structured techniques from CBT when helpful. A good integrative therapist should be able to explain clearly what their primary training is, and how they use other approaches.

What is EMDR therapy?

EMDR (Eye Movement Desensitisation and Reprocessing) is a specialist therapy developed primarily for trauma. It involves processing traumatic memories while attending to a bilateral stimulus — typically following the therapist's moving finger with your eyes. NICE recommends EMDR as an evidence-based treatment for PTSD. It is available in some NHS services and more widely in private practice, but requires specialist training.

What is EMDR effective at treating?

EMDR is most strongly evidenced for post-traumatic stress disorder (PTSD) and is recommended by NICE specifically for this condition. It is used in both NHS and private settings for single-incident trauma (such as accidents or assaults) and for more complex trauma histories. It has also been used for phobias, anxiety, and depression linked to traumatic experiences, though the evidence base for these applications is less developed than for PTSD.

Is IFS therapy evidence-based?

IFS (Internal Family Systems) is an emerging approach with a growing but still limited evidence base. The IFS Institute itself acknowledges that well-designed randomised controlled trials are still needed. Pilot studies have shown promising results for depression and PTSD, and the approach has demonstrated increases in self-compassion across multiple studies. It should be regarded as a promising practice rather than an established evidence-based treatment in the way CBT or person-centred therapy are.

Can you switch between different types of therapy?

Yes — and it can be a sensible thing to do. If you've tried one approach and found it wasn't right for you, that doesn't mean therapy won't help; it may simply mean a different approach would suit you better. Many people find that their needs change over time too: someone might benefit from structured CBT during a crisis, then move to more exploratory person-centred or psychodynamic work later. It's also worth knowing that many experienced therapists work integratively, meaning they can adapt their approach as your needs evolve.

Which type of therapy is right for me?

The right therapy depends on the nature of your difficulties, how you think, and whether you've tried therapy before. CBT suits structured thinkers dealing with anxiety, OCD or depression. Person-centred suits those who want to feel understood on their own terms. Psychodynamic suits those with longer-standing or recurring patterns. For trauma, EMDR has strong research behind it. For inner conflict, IFS or TA may resonate. Importantly, research consistently shows that the quality of the relationship with your therapist matters more than the specific modality.

How many sessions of CBT do you need?

CBT is typically delivered in 6 to 20 sessions, depending on the nature and severity of the presenting difficulties. NICE guidelines recommend around 12 to 20 sessions for depression and most anxiety disorders. NHS provision is usually at the lower end of this range. Private CBT can be more flexible. Some people find significant improvement in fewer sessions; others with more complex presentations may need more. Your therapist should review progress with you regularly and discuss whether to continue, extend, or end treatment.

Counselling Concepts

A Beginner's Guide to Different Types of Therapy

Deciding to begin therapy is a significant step. You're saying: "I'm going to invest time, money, and energy in making my life better."

But then you visit a counselling directory — such as BACP, Psychology Today, or Counselling Directory — and feel overwhelmed by terminology. Person-Centred, Psychodynamic, Integrative, Somatic… the list goes on. What is the difference? How do you choose between them? Are some better than others for your particular difficulties?

This guide aims to explain the main types of talking therapy in plain English. For each approach, I'll offer a simple summary, explain what issues it tends to be good for, describe what the theory behind it actually is, and give you a sense of what to expect from sessions. By the end, you should have a clearer idea of what you're looking for in a therapist.

However, it's also important not to get too hung up on terminology. Research consistently shows that the most important factor in whether therapy works is the relationship between you and your therapist.¹ So, while understanding the different modalities can be useful, finding a therapist you feel comfortable with matters even more. Introductory sessions are valuable for exactly this reason, and it's perfectly reasonable to speak with more than one therapist before committing.

tl;dr — Too long, didn't read?

There are many types of therapy, and no single one is right for everyone. CBT is structured and evidence-based — ideal for anxiety, OCD, and depression, and the most common NHS route. Person-centred therapy is relational and client-led, well-suited to self-worth, identity, and general wellbeing. Psychodynamic therapy explores deep-rooted patterns and is better suited to longer-term work. Integrative therapy draws on several approaches, tailored to the individual. EMDR is a specialist trauma therapy recommended by NICE. IFS and TA are newer or less mainstream approaches focusing on internal “parts” and relational patterns respectively. Above all, research consistently shows that the quality of the relationship with your therapist matters more than any specific method.

Routes via the NHS

Many people are referred for talking therapy by their GP when they present with stress, anxiety, overwhelm, or depression. The NHS route (via NHS Talking Therapies, formerly known as IAPT) will usually offer time-limited work — typically six to twenty sessions — with a Cognitive Behavioural Therapy (CBT) counsellor.

There's a good reason for that. CBT is highly effective for a range of common mental health issues, and its structured nature means it can be standardised and delivered at scale — something that matters enormously in a national health service.² This makes it well-suited to the NHS setting.

However, CBT is not the only option. While some people find it very helpful, others find it too short, too prescriptive, or feel that it isn't really addressing what's going on for them at a deeper level. If you've tried NHS therapy and found it wasn't quite right, or if you're looking at private therapy for the first time, it's worth knowing what else is available.

Cognitive Behavioural Therapy (CBT)

What is CBT?

CBT is a structured, goal-focused therapy that looks at the connections between thoughts, feelings and behaviour. The idea is that our thoughts influence how we feel, and how we feel influences what we do.

By examining and gradually changing unhelpful thought patterns and behaviours, people can start to feel and function differently. Sessions typically involve practical exercises, homework tasks, and working through specific techniques with the therapist.

What is CBT particularly good for?

CBT has the strongest evidence base of any talking therapy for anxiety disorders, including generalised anxiety, OCD, panic disorder, and social anxiety, and for depression.² It is the primary NICE-recommended treatment for phobias and is widely used for low mood.

The theory and rationale

CBT developed from two strands: cognitive therapy (developed by Aaron Beck in the 1960s, focused on how distorted thinking patterns contribute to emotional distress) and behaviour therapy (focused on how learned behaviours could be changed). The two were eventually brought together into what we now recognise as CBT.

The core idea is that thoughts, feelings and behaviours are interconnected in a cycle, so intervening in one area creates change in the others. CBT is relatively short-term, typically 6–20 sessions, and is very much a collaborative, skills-based approach. You're not just talking about your problems; you're learning tools to manage them.

What to expect, and what to look for in a therapist

CBT sessions tend to feel quite structured compared to other types of therapy. There will often be an agenda for each session, techniques like thought records or behavioural experiments, and things to practise between sessions.

A CBT therapist should be accredited with BABCP (the British Association for Behavioural and Cognitive Psychotherapies) or a similar professional body. In the UK, NHS CBT therapists are trained to a national curriculum standard.

It's worth noting that some people find CBT frustrating, particularly if they feel that their current anxious or negative thinking has deeper roots that the technique-focused approach doesn't fully address. This isn't a failing of CBT; it may simply mean a different approach would suit that person better.

Person-Centred Therapy

What is Person-Centred Therapy?

Person-centred therapy — sometimes called client-centred or Rogerian therapy, after its founder Carl Rogers — is based on the idea that people have an innate capacity and desire to grow, heal and find their own way. They just need to be given the right conditions.

Most of us don't receive those conditions consistently, and as a result many of us come to believe that we are only worthy and acceptable if… If we do something for someone, if we behave in a certain way, if we meet a particular standard.

Person-centred therapists aim to heal those wounds by forming a particular kind of relationship with clients, characterised by three things: empathy, unconditional positive regard, and congruence (or genuineness). Within that relationship, clients can work through difficult experiences and move towards becoming more fully themselves, with less self-judgement and more self-compassion.

What is Person-Centred Therapy particularly good for?

Person-centred therapy has a strong evidence base for depression and anxiety, and is the second most-delivered individual therapy in NHS Talking Therapies.³ A major 2021 randomised trial published in The Lancet Psychiatry (the PRaCTICED trial) found it to be equally effective as CBT for moderate to severe depression.⁴

It tends to be especially well-suited to people dealing with issues of self-worth, identity, relationships, or a more general sense that something isn't right. Person-centred counsellors won't diagnose you or reduce you to your symptoms; they work with the totality of you as a person.

The theory and rationale

Rogers believed that psychological distress often arises when there's a gap between who we feel we have to be (shaped by external expectations and conditional approval from others) and who we actually are — what he called the incongruence between the “ideal self” and the “actual self.”

The therapeutic relationship itself is the vehicle for change: when a person experiences being truly heard, accepted and not judged, it becomes possible to reconnect with their own experience and begin to close that gap. The therapist doesn't offer advice, interpretations or techniques; they offer presence and genuine human connection.

What to expect, and what to look for in a therapist

Sessions tend to feel less structured than CBT. The client largely directs what gets talked about, and there's usually no homework, no fixed agenda per session, and no structured treatment plan. This can feel liberating or unfamiliar depending on the person. A person-centred therapist should be registered with BACP or UKCP. In the UK, person-centred counsellors are among the most widely available in private practice.

For a more in-depth exploration of Person-Centred Therapy, read my article here.

Psychodynamic Therapy

What is Psychodynamic Therapy?

Psychodynamic therapy has its roots in psychoanalysis — the tradition begun by Freud — though it has developed substantially since then and is quite different from the classical image of lying on a couch with a silent analyst.

The central idea is that many of our emotional difficulties are driven by patterns that formed earlier in life, often outside of our conscious awareness. By exploring these patterns — particularly as they show up in the present, including in the therapeutic relationship itself — we can start to understand ourselves differently and gradually change.

What is Psychodynamic Therapy particularly good for?

Psychodynamic therapy is particularly useful for people who notice recurring patterns in their relationships or emotional life, people who feel stuck in ways they can't quite explain, and those dealing with longer-standing or more complex difficulties. Research, including a significant review published in Advances in Psychiatric Treatment, indicates it is effective for depression, anxiety, and personality difficulties.⁵

One particularly interesting finding is what researchers have called the “sleeper effect”: benefits from psychodynamic therapy can continue to develop, and even increase, after treatment has ended, suggesting that the self-understanding developed in therapy keeps working long after the sessions stop.⁶

The theory and rationale

The core assumption is that much of our psychological life is shaped by our history, and that patterns laid down in childhood (particularly in our early relationships) continue to influence how we think, feel and behave as adults, often without our realising it.

Psychodynamic therapy pays attention to defences (the ways we protect ourselves from difficult emotions), to the therapeutic relationship as a live example of those patterns, and to the way the past keeps showing up in the present.

It also uses a specific vocabulary you may have encountered, such as projection, transference, and the superego — tools for thinking about these dynamics. Compared to CBT, it tends to be less structured, longer-term, and more concerned with understanding the roots of difficulties than with managing their symptoms.

What to expect, and what to look for in a therapist

Sessions feel more open-ended than CBT, but potentially more structured than person-centred work. The therapist may reflect back, ask questions that point beneath the surface, and pay as much attention to what isn't being said as to what is.

The approach tends to be analytical and interpretive, which suits some people very well and others less so. It should generally be seen as a longer-term commitment.

A psychodynamic therapist will usually be registered with BACP, UKCP, or the BPS, and many will have completed longer postgraduate training than counsellors working in shorter-term approaches.

Integrative Therapy

What is Integrative Therapy?

Integrative therapy is an approach that doesn't commit to a single modality but draws on several. In practice, this works in two main ways. Some integrative therapists have carefully combined a specific set of approaches into a coherent model — for example, person-centred principles integrated with elements of CBT or psychodynamic thinking.

Others (perhaps more commonly in private practice) have a grounding in one or two main approaches and draw on tools and concepts from others as and when they seem useful for the individual client in front of them.

What is Integrative Therapy particularly good for?

Integrative therapy tends to be a good fit for people with complex or overlapping difficulties that don't fit neatly into a single category, and for those who have tried a more structured approach and found it wasn't quite right. Because it's flexible, it can be adapted to the individual in a way that a fixed-model approach cannot.

The theory and rationale

One of the most consistent findings across psychotherapy research is that outcomes are broadly similar across different modalities, and that what predicts a good outcome most reliably is the quality of the therapeutic relationship, rather than the specific technique used.¹ This is sometimes called the “common factors” finding, and integrative practice is in many ways a response to it. The idea being that if no single approach is definitively superior for all people in all situations, it makes sense to be guided by what serves each individual client best.

It's worth being transparent that while the common factors research is robust, there is less direct evidence that integrating approaches produces better outcomes than delivering a single approach well.⁷ However, there is evidence that person-centred therapy becomes more effective when more active, process-guiding elements are incorporated alongside the core relational approach.⁸

What matters most is the quality and consistency of the therapist's practice, whatever model they work within.

What to expect, and what to look for in a therapist

This varies considerably depending on the therapist. The most important thing is to ask directly about their training and primary orientation — what is their main grounding, and how do they use other approaches? A good integrative therapist will be able to answer this clearly. They should be registered with BACP, UKCP, or another recognised professional body.

Specialist and Emerging Approaches

Transactional Analysis (TA)

Transactional Analysis was developed by Eric Berne in the 1950s and 1960s. It offers a way of understanding personality and relationships through the concept of ego states — broadly speaking, the Parent, Adult, and Child parts of ourselves that were shaped by our experiences and that show up in how we relate to others. TA also looks at what they call “life scripts”: the unconscious narratives about ourselves and the world that we formed early in life and continue to play out.

It sits alongside IFS (below) as what might be called a “parts” framework. Both are concerned with the different internal voices or positions that make up a person's inner world. TA is particularly useful for exploring relationship patterns and communication. A meta-analysis of 41 studies published in the Transactional Analysis Journal found it to have moderate to large positive effects on psychological wellbeing.⁹

In practice, TA tends to involve collaborative exploration of patterns and language, and therapists often use diagrams or visual frameworks to map out dynamics. It is used both in individual therapy and group settings. A TA therapist will typically hold a qualification from the Institute of Transactional Analysis (ITA) or equivalent.

Internal Family Systems (IFS)

Internal Family Systems is a newer approach, developed by Richard Schwartz in the 1980s and 1990s. Like TA, it works with the idea that the mind is made up of different “parts” — each with its own perspective, feelings and role. Some parts carry burdens from past experiences; others act as protectors. At the centre of the model is the “Self”: a core of calm, curiosity and compassion that can, with practice, begin to lead a person's inner life.

IFS is growing rapidly in popularity, particularly in trauma-informed work. The evidence base is still developing, and the IFS Institute itself acknowledges that well-designed randomised controlled trials are still needed. But pilot studies have shown promising results for depression and PTSD.¹⁰

It is not yet available on the NHS and is found primarily in private practice. A qualified IFS therapist will hold specific IFS training alongside their core therapy qualification.

Eye Movement Desensitisation and Reprocessing (EMDR)

EMDR is a specialist therapy developed primarily for trauma. It involves processing difficult or traumatic memories while simultaneously attending to a bilateral stimulus — traditionally, following the therapist's moving finger with your eyes, though audio tones or physical tapping can also be used. The theory is that this bilateral stimulation allows the brain to process memories that have become “stuck” in a way that keeps triggering distress.

EMDR is recommended by NICE as an evidence-based treatment for PTSD¹¹ and is available in some NHS services, though availability is inconsistent and waiting times can be long. In private practice, EMDR therapists are more accessible, but it remains a specialist qualification with relatively few therapists working in the UK. Look for a therapist accredited with EMDR Association UK.

Which Therapy Is Right for Me?

There isn't a single correct answer to this, but there are a few things worth considering:

The nature of your difficulties. If you're dealing with anxiety, OCD, or specific phobias, CBT has the strongest evidence base and offers both structure and a clear number of sessions. For longer-standing patterns, relationship difficulties, or a sense that something deeper is going on, a relational approach — person-centred, psychodynamic, or integrative — is likely more appropriate. For trauma specifically, EMDR has a substantial body of research behind it. And if you experience a lot of inner conflict — a strong sense of being pulled in different directions, or of different “voices” inside — a parts-work approach like TA or IFS might resonate particularly well.

Whether you've tried therapy before. If you've had NHS CBT and found it wasn't right for you, that doesn't mean therapy won't help; it may simply mean a different approach would suit you better. Similarly, if you've tried person-centred and found it too unstructured, something more exploratory and analytical like psychodynamic might be worth considering.

How you think. If you're a structured thinker who likes clear processes, exercises, and things to work on between sessions, CBT is likely a good fit. If you'd rather be listened to and understood on your own terms, person-centred is a natural starting point. For those who are both creative and analytical and want to explore the roots of their experience, psychodynamic work might be more satisfying. If you want to explore different things in different ways, an integrative counsellor with the right mix might be the best match.

The therapeutic relationship. Whichever modality you choose, research consistently shows that the quality of the relationship with your therapist is one of the strongest predictors of a good outcome.¹ It is entirely reasonable — advisable, even — to have an initial consultation with more than one therapist before committing.

Practical factors. Availability varies considerably. CBT is most accessible via the NHS. EMDR specialists and IFS therapists are less common and mainly found in private practice. Person-centred, psychodynamic and integrative therapists are widely available in private practice across the UK.

How I Work

My own training is rooted in psychodynamic and person-centred approaches, with a specialism in person-centred work. In practice, I use the person-centred relationship as my foundation. I find that warmth, unconditional acceptance, and genuine curiosity allow a good, trusting relationship. We can then use that relationship collaboratively to explore tools and concepts from psychodynamic, IFS, somatic (body processing), and other frameworks where they're useful.

This also allows me to tailor my approach to you and your individual challenges and ways of thinking. Some clients benefit from more exploratory, insight-focused work; others find a more structured or directive approach more helpful at certain points. My aim is to be responsive to what each individual needs, rather than applying a fixed method regardless of the person sitting across from me.

If you'd like to know more about how I work, or to arrange an initial consultation, you can get in touch here.

Comparison Table

Approach	Best for	Suited to	Session style	Typical length	Availability
CBT	Anxiety, depression, OCD, phobias, panic	Structured thinkers with limited time	Structured, skills-based, with homework	6–20 sessions	NHS (main route) and private
Person-Centred	Depression, self-worth, identity, general wellbeing	Those who want to feel understood on their own terms	Open, client-led, relational	Open-ended; often 12–30+ sessions	Private; also NHS Talking Therapies
Psychodynamic	Recurring patterns, relationship difficulties, longer-standing issues	Creative, analytical thinkers willing to commit to a longer process	Exploratory, open-ended, interpretive	Longer-term (months to years)	Private; limited NHS availability
Integrative	Complex or overlapping difficulties; those who haven't found one approach fits	People who want a tailored rather than prescribed approach	Varies by therapist	Varies	Widely available in private practice
Transactional Analysis	Relationship patterns, communication, self-understanding	Those who want to understand their inner world and relational patterns	Collaborative, often uses frameworks and diagrams	Medium to long-term	Private practice; relatively accessible
IFS	Trauma, complex internal conflict, self-compassion	People with a strong sense of inner conflict wanting to find peace with themselves	Exploratory, parts-focused	Medium to long-term	Private practice; growing but not widely available
EMDR	PTSD, trauma	People with specific, identifiable traumatic experiences	Highly structured, uses bilateral stimulation	Typically 8–12 sessions for single-incident trauma	Some NHS; private (specialist only)

A Final Note

This guide covers the main approaches you're likely to encounter in the UK, but it's far from exhaustive — therapy is a wide field, and most experienced therapists will bring more than one influence to bear on their work regardless of their primary training. What matters most is finding someone who is properly qualified, registered with a professional body, and with whom you feel you can be honest.

If you're not sure where to start, a good first step is an initial consultation (many therapists offer introductory sessions at a reduced rate or short chats free of charge). In that initial session, you can ask about their approach and get a sense of how it might feel to work with them.

References

Wampold, B.E. & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work (2nd ed.). Routledge. See also: Norcross, J.C. (Ed.) (2011). Psychotherapy Relationships that Work. Oxford University Press.
National Institute for Health and Care Excellence (NICE). Guidelines for depression, generalised anxiety disorder, OCD, PTSD and social anxiety disorder. Available at nice.org.uk. See also: Clark, D.M. et al. (2009). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders. Behaviour Research and Therapy, 47(11), 931–941.
Haake, R. et al. (2025). How therapists operationalise the experiential components of person-centred experiential therapy in the treatment of depression. Counselling and Psychotherapy Research. doi.org/10.1002/capr.12909
Barkham, M. et al. (2021). Clinical and cost-effectiveness of person-centred experiential therapy vs. cognitive behavioural therapy for moderate and severe depression: The PRaCTICED trial. The Lancet Psychiatry, 8(6), 487–499. thelancet.com
Fonagy, P. et al. (2015). Psychodynamic psychotherapy: Developing the evidence base. Advances in Psychiatric Treatment, 21(3). cambridge.org
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. See also: NSCAP, Evidence of Effectiveness. nscap.org.uk
Byrne, A. et al. (2018). A case study of the challenges for an integrative practitioner learning a new psychological therapy. Counselling and Psychotherapy Research, 18(4). Citing Babl, A. et al. (2016) and Beitman, B.D. & Manring, J. (2009).
Cooper, M. (2019). Is Person-Centred Therapy Effective? The Facts. mick-cooper.squarespace.com. Citing Pybis, J. et al. (2017). BMC Psychiatry, 17, 347.
Vos, J. & Van Rijn, B. (2021). The evidence-based conceptual model of transactional analysis. Transactional Analysis Journal, 51(2). tandfonline.com
Hodgdon, H.B. et al. (2022). Internal Family Systems therapy for posttraumatic stress disorder among survivors of multiple childhood trauma. Journal of Aggression, Maltreatment & Trauma. tandfonline.com. See also: IFS Institute Research. ifs-institute.com/resources/research
National Institute for Health and Care Excellence (NICE). Post-traumatic stress disorder (NG116). 2018. nice.org.uk. See also: PTSD UK, NICE Guidelines for PTSD. ptsduk.org

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The views expressed in these articles are my own and are intended for general informational purposes only. They do not constitute medical, psychological, legal, or financial advice. Any references to client experiences reflect common patterns drawn from many years of practice — no individual client is identifiable or intended.