What happens in Psychotherapy? What is it?

Psychotherapy is a structured, evidence-based treatment for mental health and emotional difficulties conducted by a trained and qualified therapist. It involves regular one-to-one (or couples/family) sessions in which the therapist and client work together to understand the client's experiences, patterns of thinking and behaviour, and underlying emotional needs.

Psychotherapy differs from general counselling in that it tends to go deeper — exploring the roots of difficulties rather than just the surface symptoms. It is used to treat a wide range of conditions including anxiety, depression, trauma, relationship difficulties, identity issues and more.

Psychotherapy is not the same as psychiatry. Psychiatrists are medical doctors who can prescribe medication. Psychotherapists treat mental health through the therapeutic relationship and talk-based techniques.

Counselling is a talking therapy in which a trained counsellor helps a person explore their thoughts, feelings and behaviours in a safe, non-judgmental space. Counselling tends to be more focused on present-day challenges and practical coping strategies, though it can also explore deeper emotional patterns depending on the counsellor's training and the client's needs.

The terms counselling and psychotherapy are often used interchangeably, and many practitioners — including those at Balanced Life — are trained in both.

Cognitive Behavioural Therapy (CBT) is one of the most extensively researched and widely used forms of psychotherapy in the world. It is based on the principle that our thoughts, feelings and behaviours are deeply interconnected — and that by changing unhelpful patterns of thinking, we can change how we feel and act.

In a CBT session, your therapist will help you identify negative or distorted thought patterns, examine the evidence for and against them, and develop more balanced, realistic ways of thinking. CBT also involves practical behavioural exercises — for example, gradually facing feared situations rather than avoiding them.

CBT is particularly effective for anxiety, depression, OCD, phobias, panic disorder, and stress-related conditions. It is typically structured and goal-oriented, with noticeable results often emerging within 8–16 sessions.

EMDR stands for Eye Movement Desensitisation and Reprocessing. It is a structured therapy originally developed to treat trauma and PTSD, and is now widely used for anxiety, phobias, grief, and other distressing experiences.

EMDR works by helping the brain reprocess distressing memories that have become "stuck" — continuing to trigger intense emotional and physical responses long after the event has passed. During an EMDR session, the client recalls a distressing memory while simultaneously following a series of side-to-side eye movements (or other forms of bilateral stimulation). This process mimics what happens during REM sleep and helps the brain integrate the memory in a way that reduces its emotional charge.

EMDR is endorsed by the World Health Organisation (WHO) and the National Institute for Health and Care Excellence (NICE, UK) as an effective treatment for PTSD. Many clients experience significant relief within a relatively small number of sessions.

The Gottman Method is a research-based approach to couples therapy developed by Drs John and Julie Gottman over more than four decades of research with thousands of couples. It is one of the most evidence-based couples therapy frameworks in the world.

The Gottman Method focuses on building what the Gottmans call the "Sound Relationship House" — a framework that includes deepening friendship and intimacy, managing conflict constructively, and creating shared meaning as a couple. Therapists trained in the Gottman Method are skilled at identifying the specific patterns that predict relationship breakdown (the "Four Horsemen" — criticism, contempt, defensiveness and stonewalling) and helping couples replace them with healthier communication habits.

Geetika Malhotra at Balanced Life Psychotherapy & Counselling is trained in Gottman Method Couples Therapy at Levels 1 and 2.

Internal Family Systems (IFS) is a therapeutic model developed by Dr Richard Schwartz that understands the human mind as being made up of multiple "parts" — inner voices or sub-personalities that each carry their own perspectives, feelings and roles. Some parts protect us from pain; others carry the burden of past wounds.

IFS helps clients develop a compassionate, curious relationship with all their parts — including the ones they find most difficult or shameful — guided by the calm, grounded "Self" that exists at the core of every person. Rather than fighting or suppressing difficult emotions, IFS works with them.

IFS is effective for trauma, anxiety, depression, relationship difficulties, self-criticism, and perfectionism. It is widely regarded as a particularly gentle and respectful approach that can be transformative for people who have not responded well to more directive therapies.

Psychodynamic therapy is rooted in the understanding that our present-day difficulties are often shaped by past experiences — particularly early relationships and childhood experiences — and by unconscious patterns we are not fully aware of.

In psychodynamic therapy, the therapist helps the client explore these deeper layers: recurring patterns in relationships, defences against uncomfortable feelings, and the ways in which the past continues to influence the present. The therapeutic relationship itself is often used as a vehicle for understanding these patterns.

Psychodynamic therapy tends to be longer-term than approaches like CBT, and is particularly suited to people seeking a deeper understanding of themselves rather than just symptom relief.

Transactional Analysis (TA) is a psychological theory and therapeutic approach developed by Dr Eric Berne. It proposes that human communication and behaviour can be understood through three "ego states" — Parent, Adult and Child — and that many of our difficulties arise from patterns of interaction (transactions) that were formed in childhood and continue to play out in adult life.

In TA therapy, the therapist helps the client understand these patterns, identify early decisions and life scripts that may be limiting them, and develop healthier ways of relating to themselves and others. TA is used in individual therapy, couples therapy and group settings.

Solutions Focused Therapy (SFT) is a brief, goal-oriented therapeutic approach that focuses on what the client wants to achieve rather than analysing the problem in depth. Rather than spending extensive time exploring the origins of a difficulty, SFT looks at what is already working in the client's life, what their preferred future looks like, and what small steps they can take to move towards it.

SFT is particularly useful for clients who want practical, forward-looking support and who respond well to a collaborative, strengths-based approach.

Existential therapy is a philosophical approach to psychotherapy that explores the fundamental questions of human existence — meaning, freedom, responsibility, isolation and mortality. Rather than treating psychological distress as a disorder to be fixed, existential therapy sees it as an invitation to examine how we are living and what truly matters to us.

It is particularly suited to people going through major life transitions, questioning their purpose, facing loss or mortality, or feeling a deep sense of meaninglessness despite outwardly successful lives.

Humanistic therapy is an umbrella term for therapeutic approaches that emphasise the inherent worth of every person and their capacity for growth, self-awareness and self-determination. It includes approaches such as Person-Centred Therapy (developed by Carl Rogers), which prioritises unconditional positive regard, empathy and genuineness as the core conditions for therapeutic change.

Humanistic approaches underpin much of modern therapy practice and are often integrated with other modalities.

An integrative psychotherapist draws on multiple therapeutic modalities rather than working exclusively within one framework. The choice of approach is guided by the individual client's needs, personality, goals and the nature of their difficulties — rather than fitting every client into the same model.

All therapists at Balanced Life work integratively. This means your therapy is tailored to you from the very first session.

Anxiety is a natural human emotion — a response to perceived threat or uncertainty. In moderate amounts it is useful, keeping us alert and motivated. It becomes a problem when it is persistent, disproportionate to the situation, and starts to interfere with daily life.

Anxiety can manifest as constant worry, physical symptoms (racing heart, tight chest, difficulty breathing, sweating), panic attacks, avoidance of feared situations, difficulty sleeping, or a general sense of dread. Common forms include Generalised Anxiety Disorder (GAD), Social Anxiety Disorder, Panic Disorder, Health Anxiety, and specific phobias.

Anxiety is highly treatable with psychotherapy, particularly CBT and EMDR. You do not have to live with it.

Depression is more than feeling sad or going through a difficult patch. It is a persistent low mood that affects how you think, feel and function — often for weeks or months at a time. Depression can make even ordinary tasks feel exhausting, drain motivation and pleasure from activities you used to enjoy, and distort your thinking into believing things will never improve.

Symptoms include persistent low mood, loss of interest or pleasure, fatigue, changes in sleep and appetite, difficulty concentrating, feelings of worthlessness or guilt, and in severe cases, thoughts of death or suicide.

Do I have depression? A common question.

Depression is one of the most common and most treatable mental health conditions. Psychotherapy — particularly CBT and psychodynamic approaches — is an effective treatment, often in combination with medication for moderate to severe cases.

Burnout is a state of chronic exhaustion — physical, emotional and mental — caused by prolonged exposure to excessive stress, usually in a work context. It is not simply tiredness. Burnout fundamentally depletes your sense of self, your motivation, and your capacity to engage with the things that used to matter to you.

The World Health Organisation officially recognises burnout as an occupational phenomenon. Symptoms include emotional exhaustion, growing cynicism or detachment from work, and a reduced sense of professional efficacy.

Burnout is particularly common in Singapore's high-performance work culture, among expats navigating demanding international careers, and among caregivers. It responds well to therapy, particularly approaches that address the deeper values and identity questions that often underlie burnout.

Trauma is the lasting emotional and psychological impact of an event or series of events that was overwhelming, threatening or deeply distressing. Trauma is not defined by the event itself but by how it affected the person experiencing it — what is traumatic for one person may not be for another.

Trauma can result from a single event (an accident, assault, bereavement) or from prolonged exposure to difficult circumstances (childhood abuse or neglect, domestic violence, chronic illness). Symptoms include flashbacks, nightmares, hypervigilance, emotional numbing, avoidance, and difficulty trusting others.

EMDR is one of the most effective evidence-based treatments for trauma and PTSD. Psychodynamic and IFS approaches are also widely used.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity and/or impulsivity that are inconsistent with the person's developmental level and significantly interfere with functioning.

ADHD is not a lack of intelligence or effort — it is a difference in how the brain regulates attention, impulse control and executive function. It affects children and adults and presents differently across genders, ages and intelligence levels. Many highly intelligent and successful people have ADHD that went undiagnosed for years.

A formal assessment is required for diagnosis. At Balanced Life, private ADHD assessments are available for both children and adults, with results typically available within weeks.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how a person communicates, processes social information, and experiences the world. The word "spectrum" reflects the enormous diversity of how autism presents — no two autistic people are the same.

Common characteristics include differences in social communication and interaction, strong preferences for routine and predictability, deep focus on specific interests, and sensory sensitivities. Autism is not a mental illness — it is a different neurological profile. Many autistic people lead full, rich lives and do not seek or need treatment beyond understanding and appropriate accommodation.

A formal assessment is the only way to confirm a diagnosis. Balanced Life offers private ASD assessments for children and adults in Singapore.

Burnout and depression share many symptoms and are often confused — and they can co-occur. The key distinction is origin and scope. Burnout is primarily situational — tied to chronic work or caregiver stress — and tends to improve significantly when the stressor is removed or reduced. Depression is a broader condition that affects all areas of life, persists regardless of circumstances, and has deeper biological and psychological roots.

That said, untreated burnout can develop into clinical depression. If you are unsure which you are experiencing, a therapist can help you understand what is going on and what kind of support will help most.

A Third Culture Kid (TCK) is a person who has grown up in a culture or cultures different from their parents' home culture — typically as the child of expats, diplomats, military families or international business professionals. The "third culture" refers to the hybrid cultural identity that develops from living between two or more worlds.

TCKs often have rich, broad perspectives and deep cross-cultural competence. They also frequently face challenges around identity, belonging, rootlessness, and the grief of repeated transitions and goodbyes. Therapy with a therapist who understands the TCK experience can be particularly valuable for young people and adults navigating these unique challenges.

A psychological assessment is a structured evaluation conducted by a trained psychologist using standardised, validated tools to understand a person's cognitive, emotional, behavioural or neurological functioning. Assessments result in a written report with findings, a diagnosis where applicable, and recommendations for support, treatment or accommodations.

Psychological assessments are used to diagnose conditions such as ADHD, ASD/Autism, learning disorders, intellectual disabilities, personality disorders, and cognitive impairment. They are also used to determine IQ and cognitive profile for educational or occupational purposes.

At our practice, assessments are conducted by Vincent Ng, a registered psychologist and doctoral candidate in Clinical Psychology.

These terms are often confused. Here is a plain-language breakdown:

**Psychiatrist:** A medical doctor who specialises in mental health. Psychiatrists can diagnose mental health conditions, prescribe medication, and also provide therapy. They typically see patients with more severe or complex conditions.

**Psychologist:** A mental health professional with a degree in psychology (typically a Masters or Doctorate). Psychologists conduct psychological assessments and may provide therapy. They cannot prescribe medication in Singapore.

**Psychotherapist:** A mental health professional trained in one or more specific forms of psychotherapy. The title is not legally regulated in Singapore, so it is important to check qualifications and professional memberships. At Balanced Life, our psychotherapist holds internationally recognised qualifications and is registered with the SAC and BACP.

**Counsellor:** A trained professional who uses talking therapy to help people address specific challenges. Counsellors typically focus on present-day concerns and practical coping. The title is not legally regulated in Singapore — again, check qualifications and memberships.

In practice, many practitioners hold training and registration across more than one of these roles.

Therapy (psychotherapy or counselling) is focused on healing — addressing emotional distress, mental health conditions, trauma, relationship difficulties, and patterns of thinking and behaviour that are causing suffering. It often involves exploring the past as well as the present.

Coaching is focused on performance and growth — helping a person identify goals, develop strategies, and move forward in their professional or personal life. It generally assumes the person is psychologically well and focused on optimising rather than healing.

Executive coaching at Balanced Life is provided by Rashmi Gogna, a certified executive coach trained at INSEAD, and is designed for senior leaders and high-performing professionals.