CBT, ACT, CFT or family therapy: which one fits?
Two people arrive at a first appointment on the same morning. One has developed a fear of driving since a near miss on the A26 and wants it gone. The other has felt not good enough for as long as she can remember, has tried CBT twice, and describes it as “arguing with myself and losing”. Both are anxious. They probably need different therapies.
The approaches I use each grew out of a different insight about how people get stuck, and that is the most useful way to think about which might fit you.
| Approach | Built on the idea that | Often suits |
|---|---|---|
| CBT | Problems are kept going by specific thoughts and behaviours you can test and change | A clear, current problem such as panic, phobias, OCD, health anxiety or trauma |
| ACT | Fighting thoughts and feelings often keeps you stuck; flexibility and values free you up | Long-running anxiety, stress, chronic pain, people who have tried to think their way out |
| CFT | Shame and self-criticism keep the threat system switched on | Harsh inner critic, perfectionism, shame, low mood that doesn’t respond to logic |
| Systemic ideas | Problems live in relationships and patterns, not just inside one person | Family conflict, relationship patterns, one person’s difficulties affecting everyone |
| Narrative ideas | The stories we tell about ourselves can be rewritten | Identity, loss, experiences of being defined by a problem |
In practice, the choice isn’t usually made by you alone or by me alone. The first sessions build a formulation, a shared map of what is happening and why, and the approach comes from that. Many people end up with a blend: CBT techniques for a specific fear, alongside compassion-focused work for the self-criticism underneath it.
The driver above would likely do well with focused CBT. The woman who has felt not good enough for decades may find compassion focused therapy speaks to something CBT couldn’t reach.
If you are unsure which fits, that is exactly what an initial consultation is for. See what I help with, or get in touch.