Our Approach to Therapy
At Perfectly Aligned Psychology we use four main evidence-based approaches: cognitive behaviour therapy, acceptance and commitment therapy, schema therapy and EMDR. For anyone looking for a Wollongong CBT psychologist or schema therapy in Wollongong, this page explains what each approach involves, what it suits, and how we decide together which to use.
Many people arrive having heard of one approach from a friend, a podcast or a previous therapist. Others have no idea what the options are and simply want to feel better. Both are good starting points.
You do not need to choose an approach before booking. That decision is part of the first few sessions, once we understand what is happening and what you want to change.
This page is part of our wider information about Perfectly Aligned Psychology, including our standards and the rooms in Balgownie.
How do we choose an approach?
We choose an approach after assessment, based on the problem, the research behind each option, your goals and your preferences. For example, schema therapy suits long-standing patterns, EMDR suits memories that still feel raw, and CBT suits most anxiety and depression. The plan is agreed with you, not imposed.
Whether you are searching for schema therapy in Wollongong or simply want help with anxiety, the first step is the same. We spend the first session understanding the history of the problem, what keeps it going, and what you have already tried.
From there, we explain the options in plain language, including what each would ask of you. Some approaches involve homework between sessions. Some focus more on the past, others more on the present.
Your preferences matter. Research on therapy consistently shows that the working relationship and a sense of agreement about the method are strongly linked to good outcomes.
Approaches are often combined. Someone might use CBT skills for panic while EMDR processes the memory that started it, or ACT to live with chronic pain while schema work addresses harsh self-criticism.
What is cognitive behaviour therapy?
Cognitive behaviour therapy, or CBT, is a structured approach that helps you notice the links between thoughts, feelings and behaviour, then change the patterns that keep problems going. It has the strongest research base of any psychological therapy for anxiety and depression, and it is usually time-limited and practical.
In CBT, we map out a cycle together. For example, a worried thought leads to a racing heart, which leads to avoiding a situation, which brings short-term relief but makes the worry stronger next time.
Once the cycle is clear, you learn skills to interrupt it. These include challenging unhelpful thoughts, gradually facing feared situations, solving problems step by step, and building activities that lift mood.
Between sessions, there is usually something to practise, such as a thought record or a small experiment. Much of the change happens in daily life, not just in the room.
CBT is used for panic, social anxiety, generalised worry, depression, insomnia, obsessive-compulsive symptoms, and many problems in children and teenagers. Trauma-focused CBT is one of the recommended treatments for post-traumatic stress.
As a Wollongong CBT psychologist, [Psychologist name] adapts the approach to each person, so it feels practical and relevant rather than like a worksheet exercise. Our page on individual therapy for adults describes how CBT is used for common concerns.
What is acceptance and commitment therapy?
Acceptance and commitment therapy, or ACT, helps you make room for difficult thoughts and feelings instead of fighting them, while taking steps toward what matters most to you. It builds psychological flexibility, and it is especially useful for chronic pain, ongoing stress, perfectionism and problems that cannot simply be fixed.
ACT starts from the idea that pain is part of life, and that the struggle against it often causes more suffering than the pain itself.
Rather than changing the content of thoughts, ACT changes your relationship with them. You learn to notice a thought such as "I am not good enough" as a thought, not a fact, so it has less control over what you do.
A central part of ACT is clarifying your values: what kind of person you want to be, and what you want your life to be about. Actions are then chosen to move toward those values, even when anxiety or doubt shows up.
Mindfulness skills are woven through ACT, but they are practical and brief, not long meditations.
ACT suits people who have tried to think their way out of problems without success, and people facing circumstances that cannot be changed, such as illness, injury or loss.
What is schema therapy?
Schema therapy is an integrative approach for long-standing patterns that began in childhood, such as feeling defective, abandoned or never good enough. It combines CBT, attachment ideas and experiential techniques, and it is used for chronic depression, persistent relationship difficulties and personality patterns that shorter therapies have not shifted. [Confirm schema therapy training.]
Schema therapy was developed by psychologist Jeffrey Young, who noticed that some people did not respond fully to standard CBT because their difficulties were rooted in deep, early patterns.
These patterns are called schemas. Common examples include a sense of emotional deprivation, fear of abandonment, mistrust, or harsh self-criticism. They are often triggered in adult relationships and at work.
Therapy helps you recognise when a schema has been activated, understand where it came from, and meet the unmet needs behind it. Techniques include imagery, dialogue exercises and building a kinder, stronger inner voice.
Schema therapy usually takes longer than CBT, often many months. It suits people who feel stuck in the same painful patterns despite understanding them.
For people searching for schema therapy in Wollongong, we offer it face to face in Balgownie as well as over video.
How does EMDR fit into our approach?
EMDR (eye movement desensitisation and reprocessing) is designed for memories that still feel raw or intrusive. It uses bilateral stimulation, such as eye movements or taps, while you briefly focus on a memory, helping the brain process it so it feels less distressing. It is a recommended treatment for post-traumatic stress.
EMDR follows eight phases, starting with history and preparation, then reprocessing target memories, and finishing with work on present triggers and future situations.
It does not require talking about a memory in great detail, which some people find a relief.
EMDR is used for post-traumatic stress, single traumatic events, and anxiety or phobias that began with a specific experience. It can be combined with CBT or ACT when other difficulties are also present.
Our page on EMDR therapy in Wollongong explains the phases, what a session feels like, and how it works by telehealth. For a side-by-side comparison, read EMDR versus CBT.
| Approach | Best suited to | Typical length | Focus |
|---|---|---|---|
| CBT | Anxiety, depression, panic, insomnia | 6 to 20 sessions | Present patterns and skills |
| ACT | Chronic pain, stress, perfectionism | 8 to 16 sessions | Values and flexibility |
| Schema therapy | Long-standing patterns, chronic depression | Many months | Early patterns and needs |
| EMDR | Trauma, PTSD, memory-linked fears | 6 to 16 sessions, often more for complex trauma | Distressing memories |
How do we measure progress?
We measure progress with short, validated questionnaires at the start of therapy and at regular review points, alongside your own sense of change. Reviews usually happen every six sessions or so. If progress stalls, we talk about it openly and adjust the plan.
Common measures include the K10 for general distress, the DASS-21 for depression, anxiety and stress, and specific measures for trauma or particular problems.
Numbers are only part of the picture. We also check in on the things you said mattered at the start, such as sleeping through the night, returning to work, or feeling closer to family.
Some clinics also use a brief rating at the end of sessions about how the session felt. [Confirm whether session rating scales are used.] It gives you a simple way to say if something is not working.
Measuring progress keeps therapy honest. It shows when it is time to change approach, reduce session frequency, or finish.
How do we work with your GP or psychiatrist?
With your consent, we keep your GP updated with brief progress reports, especially under a Mental Health Treatment Plan. Where medication or specialist care is involved, we liaise with your psychiatrist or paediatrician so everyone works from the same plan.
Your GP remains central to your overall health care. They can review medication, check physical health and coordinate other services.
Psychiatrists are medical doctors who specialise in mental health and can prescribe medication. For some people, a combination of therapy and medication works best, and we will discuss this openly if it could help. Our guide to psychologists and psychiatrists explains the difference between the two roles.
We only share what is needed, and we tell you what we have sent. You can ask to see any report.
If you would like support finding a psychiatrist or other service, we can suggest options in the Illawarra and online. The Black Dog Institute also has helpful information on treatment options for depression and anxiety.
To see how all of this fits across the practice, visit the Perfectly Aligned Psychology homepage.
This page describes the therapeutic approaches used at Perfectly Aligned Psychology in general terms. The right approach for you depends on an individual assessment, and session numbers vary widely from person to person.
Questions about our approach
Which approach is best for anxiety?
For most anxiety problems, cognitive behaviour therapy has the strongest evidence, particularly for panic, social anxiety and generalised worry. When anxiety began with a specific frightening experience, EMDR can be very effective. ACT can help when anxiety is tied up with perfectionism or chronic stress. We decide together after assessment.
Do you combine approaches?
Yes, often. Many people have more than one difficulty, and approaches work well together. For example, CBT skills can help manage panic day to day while EMDR processes an underlying memory, or ACT can support living with pain while schema therapy addresses harsh self-criticism. Any combination is explained and agreed first.
How do you know therapy is working?
We use short questionnaires at the start and at regular reviews, and we check progress against the goals you set, such as sleeping better or returning to activities you had stopped. If things are not improving, we discuss why and adjust the plan rather than simply continuing.
Find the approach that fits
Book a first session and we will talk through the options together.