Chartered Clinical Psychologist
International and Private Care
Great Ormond Street Hospital for Children
Great Ormond Street
London WC1N 3JH
Clinical Approach
While every individual is unique, different types of psychiatric disorder and other psychological difficulties are characterised by patterns of thought and behaviour that present in similar ways among those experiencing them. These often involve feedback cycles, whereby habitual or instinctive responses to particular experiences inadvertently serve to reinforce difficulties. In clinical psychology, interventions are guided by our understanding of the specific patterns associated with different types of difficulty and involve methods to disrupt these cycles.
The following sections describe common patterns of thought and behaviour that characterise specific psychological difficulties, as well as a brief description of the treatment approaches used at Waypoint.
Anxiety Disorders
Anxiety, like other emotions, plays an important role in guiding our behaviour. When faced with potential harm, it leads to protective responses (e.g., fleeing from a dangerous animal). However, anxiety can sometimes be disproportionate to the level of risk in particular situations. Car alarms are often used as a metaphor to illustrate this point. They serve an important purpose if someone is breaking into your car at night, but cause unnecessary stress if they are set off by small gusts of wind.
Research shows that people with anxiety disorders tend to over-estimate both the likelihood of something bad happening and the severity of potential harm. This can lead to avoidance of activities or use of safety behaviours to make them feel less threatening. When someone learns to associate the avoidance of situations and activities with a reduction in their anxiety, this behaviour is made more likely when they are faced with similar situations in the future (i.e., what psychologists call a ‘conditioned response’). It also means that they don’t have an opportunity to see that the outcome they fear is not as likely or as harmful as they think.
Treatment programs for anxiety ‘expose’ patients, in a controlled way, to things that provoke their anxiety. By starting with less confronting situations (e.g., for someone with a fear of heights, standing on a second-floor balcony) and gradually building up to more confronting situations (e.g., abseiling), each individual step feels achievable. At the same time, patients’ thoughts are explored, and psychotherapeutic methods are used to re-evaluate perceived threat. These are some of the core elements of cognitive-behavioural therapy (CBT) for anxiety.
Different types of anxiety involve specific types of perceived threat and require differing sorts of treatment. For example, panic attacks are characterised by a ‘catastrophic misinterpretation’ of bodily signals and mental experiences associated with anxiety. Anxiety can sometimes involve a tightness in one’s chest, for example, which someone with panic may interpret as a sign that they’re having a heart attack. Similarly, racing thoughts and difficulty thinking clearly might be interpreted as someone ‘going mad’. By causing more anxiety, these misinterpretations contribute to a self-feeding cycle whereby their worry causes anxiety symptoms and vice versa. Treatment for panic attacks therefore often involves exposure to bodily sensations associated with anxiety and re-evaluation of their perceived threat.
Trauma and PTSD
Thoughts and memories of a traumatic event can be so distressing that an individual's mind may protect itself by pushing these aside or locking them away. While this helps to reduce distress in the short-term, it can sometimes mean that traumatic events are not processed, made sense of, or integrated with other memories and experiences. For this reason, traumatic memories can remain unstable and come to mind at inconvenient times or be triggered by particular experiences. A helpful metaphor is that of a cupboard, where stable memories are stored like neatly stacked pots and pans. Traumatic memories can be likened to pots that have been tossed into the cupboard and rest against the closed cupboard door. When other memories are accessed, traumatic memories are prone to tumbling out in an uncontrolled and distressing way.
Post-traumatic stress disorder (PTSD) is characterised by intrusive thoughts and memories, which come to mind despite someone not wanting to think about them. For some people, this 're-experiencing' can involve dissociation, whereby they literally feel as though they are back at the scene of their trauma, or nightmares about the experience. PTSD also involves heighted physical arousal, which can contribute to agitation and difficulties sleeping. As a result of their distress, people with PTSD may tend to avoid situations, people, or thoughts that lead to memories about their trauma. In treatment, patients are helped to regain control over their lives by addressing this avoidance in a similar way to the methods described in relation to anxiety (see above).
Trauma-focused cognitive-behavioural therapy (TF-CBT) is the gold standard treatment for PTSD. Recent professional guidelines have reaffirmed TF-CBT as a first-line treatment, over alternative therapies like 'eye-movement desensitisation and reprocessing' (EMDR). In addition to techniques that target other types of avoidance (e.g., of places or experiences that remind someone of their trauma), particular attention is paid to activities that facilitate processing of traumatic memories. Prolonged exposure is one such technique, whereby patients talk through the detail of their traumatic memories with the support of the therapist. While these activities can be confronting to begin, the distress associated with traumatic memories is reduced with repetition. I have witnessed incredible transformations, using these techniques, in patients with trauma ranging from fatal dog attacks and car crashes, to violent sexual and physical assault.
Complex PTSD is a type of disorder that involves compounding difficulties based on the way that traumatic experiences can make us more vulnerable to future trauma. Someone that has experienced childhood abuse or domestic violence, for example, may develop attachment difficulties that make them more likely to enter into problematic future relationships. Similarly, returned servicemen and women may be more inclined to respond violently to perceived threats and have further difficulties as a result of these altercations. In addition to conventional trauma-focused treatment, techniques to address complex PTSD may involve methods that have traditionally been used to treat personality disorders (e.g., dialectical behaviour therapy). For childhood trauma that continues to impact adult relationships, schema therapy provides an evidence-based treatment approach.
Obsessive-Compulsive Disorder
People with obsessive-compulsive disorder (OCD) experience something known as 'thought-action fusion', whereby thinking about a scenario increases their perception of the event's likelihood and imagining an action feels morally equivalent to actually doing it. As a result, they are prone to experiencing unwanted and repetitive (i.e., 'intrusive') thoughts (e.g., that the iron might have been left on or that they may have been contaminated by something unhygienic).
Individuals with OCD can also struggle with 'egodystonic thoughts'. Most people have experienced these types of thoughts at some point, whereby we briefly imagine doing something that is not aligned with our morals or intentions. These might include, for example, a thought about pushing someone in front of a train or doing something sexually inappropriate. Most people can dismiss these thoughts as strange but harmless experiences. However, though-action fusion can make these thoughts highly distressing for people with OCD and it can become difficult to stop thinking about these scenarios.
The term 'obsession' is used to describe intrusive thoughts, including egodystonic thoughts, that can be difficult for someone to stop thinking about. Physical and mental behaviours are sometimes used by people with obsessions to reduce their anxiety. These 'compulsions' might be logically related to the obsession but excessive in their use (e.g., hand-washing based on concern about contamination). Alternatively, through a process known as 'magical thinking', people with OCD may have compulsions that do not relate logically to their obsession (e.g., bidding farewell to a loved one in a specific way that is intended to prevent harm coming to them). By providing temporary relief from anxiety, compulsions become reinforced through conditioning (i.e., the behaviour is made more likely and harder to resist the next time their obsession is experienced).
The most well-established behavioural intervention for OCD involves gradual exposure to experiences that trigger an obsession and practice resisting the related compulsion. Through a process known as 'extinction learning', the association between obsession and compulsion is gradually reduced. Cognitive therapy is also provided to help clients re-evaluate their beliefs and recognise that their feared scenarios will not eventuate. In conjunction with other techniques, this cognitive-behavioural approach is used to help clients free themselves from the distress associated with their obsessions and burden of their compulsions. I have seen fantastic outcomes for patients that I have treated using these techniques, including with severe and debilitating obsessions about such things as contamination (e.g., germs and incontinence), harm to others (i.e., physical and sexual), morality, security (e.g., at home and digital), and transformation (e.g., sexual orientation).
Relationships/Couples Therapy
The best relationships are founded on mutual trust and understanding. When communication deteriorates in a relationship, partners often find themselves caught in cycles of misunderstanding, frustration, and emotional distance. Without effective communication, assumptions replace clarity, and partners may begin to feel unseen, unheard, or invalidated. Over time, this can erode trust, increase conflict, and create emotional disconnection.
In these strained dynamics, partners frequently misinterpret each other’s intentions, reacting defensively or withdrawing altogether. Hurt feelings may go unspoken, while unmet needs slowly accumulate, fuelling resentment. Intimacy declines as emotional safety gives way to criticism, silence, or avoidance.
A key factor in this breakdown lies in the difference between primary and secondary emotions. Primary emotions are often vulnerable and immediate - such as sadness, fear, or hurt - but they are rarely expressed directly. Instead, they are masked by more reactive secondary emotions like anger, irritation, or blame. These secondary emotions can dominate interactions, pushing partners further apart and obscuring the deeper feelings that actually need recognition and care.
Through emotionally focused couples therapy (EFCT), I help couples to slow down these reactive cycles and learn to identify and share their underlying emotional experiences. As they begin to communicate from a place of vulnerability rather than defence, they often find new empathy for one another. With the support of a therapist, couples can begin to rebuild trust, improve emotional responsiveness, and re-establish a more secure and connected relationship.
Parenting Support
I offer parenting support to assist caregivers in navigating the many complexities and emotional demands of raising children. While commonly-used strategies such as time-out, reward charts, and behavioural plans are often recommended, they can be challenging to implement consistently, and may not always produce the desired outcomes. My approach involves working collaboratively with parents to develop strategies that are both practical and tailored to the individual needs of the child and demands of the family context.
In addition to offering guidance on specific techniques, I support parents to reflect on the emotional and relational patterns that develop over time. Often, cycles of behaviour and response - between parent and child - can unintentionally reinforce difficulties. Increasing awareness of these patterns can be a key step in bringing about meaningful and lasting change.
Children do not come with a handbook. Parenting support is not about criticism or blame, but about fostering greater understanding, flexibility, and confidence. Through thoughtful reflection and evidence-based techniques, we can work together to strengthen the parent-child relationship and support the development of a calmer, more connected family environment.