Understanding Different Types of Therapy

The main types of therapy are cognitive behavioral therapies (CBT and offshoots such as DBT and ACT), psychodynamic therapies, humanistic therapies (person-centered, Gestalt, existential and emotion-focused), trauma-focused therapies such as EMDR, couples and family therapies, and a range of specialized and integrative approaches such as schema therapy, interpersonal therapy and internal family systems. They differ in what they see as the cause of distress, how structured sessions are, and whether the focus is on the present, the past, the body or relationships.

This hub explains the different types of therapy, what each involves, and what research says about them. Use it to understand your options and to have better conversations with a mental health professional; it is educational and cannot tell you which treatment is right for you.

Therapy Basics

What is Psychotherapy?

Psychotherapy, also called talk therapy or counseling, is a collaborative treatment based on the relationship between a person and a trained professional. It provides a structured, confidential space to understand difficulties and develop new ways of thinking, feeling and acting. Our overview of what therapy is covers the basics in more depth.

How Therapy Works

Therapy works through several mechanisms:

• Therapeutic relationship: The bond between client and therapist facilitates healing
• Safe space: Non-judgmental environment for exploration
• Insight development: Understanding patterns and root causes
• Skill building: Learning new coping strategies
• Emotional processing: Working through difficult feelings
• Behavioral change: Modifying unhelpful patterns
• Learning and brain change: Like other learning, therapy is associated with measurable changes in brain activity in some studies, reflecting neuroplasticity, although these findings are still being refined

Common Factors Across Therapies

Research suggests that some ingredients matter across all approaches, often called "common factors":

• Therapeutic alliance: the bond and agreement on goals and tasks between client and therapist. Meta-analyses find it is one of the most consistent predictors of outcome (see therapeutic alliance).
• Client factors: motivation, life circumstances and social support.
• Hope and expectancy: believing that therapy can help.
• Specific techniques: the methods of a particular approach, which matter more for some problems (such as exposure for phobias and OCD) than others.

A widely quoted breakdown, from psychologist Michael Lambert in 1992, estimated these at roughly 40%, 30%, 15% and 15% of improvement. Lambert presented these as rough estimates rather than measured values, and they should not be read as precise figures. The debate about how much specific techniques matter, summarized in Wampold and Imel's The Great Psychotherapy Debate, is still active.

Therapy Formats

Therapy can be delivered in various formats:

• Individual therapy: One-on-one sessions with a therapist
• Group therapy: Working with others facing similar issues
• Couples therapy: Partners working on relationship issues
• Family therapy: Addressing family dynamics and patterns
• Online therapy: Video, phone, or text-based sessions
• Intensive programs: Day treatment or residential programs

The Most Intensive Types of Therapy

Therapies also vary a great deal in intensity. Among the most intensive are classical psychoanalysis (three to five sessions a week, often for years), comprehensive DBT (individual therapy, a skills group and phone coaching every week), intensive outpatient and partial hospitalization programs (several hours a day, several days a week), residential treatment, and concentrated "intensive" formats of trauma therapies delivered daily over one to two weeks. More intensive does not automatically mean better; intensity is usually matched to how severe and complex a person's difficulties are.

Cognitive Behavioral Therapy (CBT)

Overview

CBT (cognitive behavioral therapy) is one of the most extensively researched and widely practiced forms of psychotherapy. It focuses on identifying and changing negative thought patterns and behaviors that contribute to emotional distress.

Core Principles

• Cognitive model: Our thoughts influence our emotions and behaviors
• Present-focused: Emphasis on current problems rather than past
• Collaborative: Therapist and client work as a team
• Goal-oriented: Clear, measurable objectives
• Time-limited: Typically 12-20 sessions
• Structured sessions: Agenda, homework, skill practice

Key Techniques

• Cognitive restructuring: Identifying and challenging distorted thoughts
• Thought records: Tracking thoughts, emotions, and evidence
• Behavioral activation: Scheduling pleasant activities
• Exposure therapy: Gradual confrontation of fears
• Problem-solving: Systematic approach to challenges
• Relaxation training: Managing physical tension
• Homework assignments: Practicing skills between sessions

Common Cognitive Distortions Addressed

• All-or-nothing thinking: Seeing things in black and white
• Overgeneralization: One event represents all events
• Mental filter: Focusing only on negatives
• Mind reading: Assuming you know what others think
• Catastrophizing: Expecting the worst possible outcome
• Personalization: Taking responsibility for things outside your control

Effectiveness

CBT is the most widely studied form of psychotherapy, with hundreds of trials. A 2012 review of meta-analyses by Stefan Hofmann and colleagues found the strongest support for anxiety disorders, somatic symptom problems, bulimia, anger control and general stress, with good support for depression. Response rates vary by condition and study, and not everyone improves. Evidence supports CBT-based approaches for:

• Depression
• Anxiety disorders, including panic disorder and social anxiety
• PTSD (especially trauma-focused forms such as cognitive processing therapy and prolonged exposure)
• OCD (through exposure and response prevention)
• Eating disorders
• Substance use disorders
• Insomnia
• Chronic pain
• Some personality disorders (usually via specialized adaptations)

CBT Variations

• Trauma-Focused CBT: For children and teens affected by trauma, with caregiver involvement
• CBT-I: Specialized protocol for insomnia
• CBT-E: Enhanced version for eating disorders
• Mindfulness-Based Cognitive Therapy: Integrates mindfulness practices to prevent depressive relapse
• Behavioral activation: A simpler behavioral approach for depression with strong evidence

Dialectical Behavior Therapy (DBT)

Overview

DBT (dialectical behavior therapy) was originally developed by Marsha Linehan for treating borderline personality disorder but has since been adapted for various conditions involving emotional dysregulation.

Core Philosophy

DBT balances two seemingly opposing strategies:

• Acceptance: Acknowledging and validating current reality
• Change: Working toward improvement and growth
• Dialectics: Holding two truths simultaneously

Four Modules of DBT Skills

1. Mindfulness

• Observe, describe, participate
• Non-judgmental stance
• One-mindfully (focus on one thing)
• Effectiveness (doing what works)
• Wise mind (balancing emotion and logic)

2. Distress Tolerance

• TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation)
• Distraction techniques (ACCEPTS)
• Self-soothing with five senses
• Radical acceptance
• Crisis survival skills

3. Emotion Regulation

• Understanding and naming emotions
• Reducing vulnerability (PLEASE skills)
• Opposite action
• Checking the facts
• Problem-solving

4. Interpersonal Effectiveness

• DEAR MAN (asking for what you need)
• GIVE (maintaining relationships)
• FAST (maintaining self-respect)
• Validation skills
• Setting boundaries

DBT Treatment Structure

• Individual therapy: Weekly one-on-one sessions
• Skills group: Weekly 2-2.5 hour group sessions
• Phone coaching: Between-session support
• Consultation team: Support for therapists

Effectiveness

DBT has its strongest evidence for borderline personality disorder and for reducing self-harm and suicidal behavior, where several randomized trials, including Linehan's own, found reductions compared with other treatments. Adaptations have been studied for:

• Eating disorders, particularly binge eating and bulimia
• Substance use alongside emotional dysregulation
• PTSD (DBT-PE, combining DBT with prolonged exposure)
• Adolescents with self-harm (DBT-A)
• Bipolar disorder and ADHD, where evidence is still preliminary

Psychodynamic Therapy

Overview

Psychodynamic therapy evolved from psychoanalysis and focuses on unconscious processes, early life experiences, and the therapeutic relationship as vehicles for change. Many of its ideas draw on attachment theory and how early relationships shape later ones.

Core Concepts

• Unconscious mind: Much of mental life occurs outside awareness
• Defense mechanisms: Psychological strategies to protect from anxiety
• Transference: Projecting feelings about others onto therapist
• Countertransference: Therapist's emotional response to client
• Attachment patterns: Early relationships shape current ones
• Inner conflict: Competing desires and motivations

Key Techniques

• Free association: Saying whatever comes to mind
• Dream analysis: Exploring symbolic meaning
• Interpretation: Therapist offers insights about patterns
• Working through: Repeatedly examining issues from different angles
• Analysis of resistance: Exploring avoidance and defensiveness
• Exploration of past: Understanding how history impacts present

Common Defense Mechanisms Explored

• Denial: Refusing to acknowledge reality
• Projection: Attributing own feelings to others
• Displacement: Redirecting emotions to safer target
• Rationalization: Logical explanations for emotional responses
• Repression: Unconsciously blocking memories
• Sublimation: Channeling impulses into acceptable activities

Types of Psychodynamic Therapy

• Psychoanalysis: Intensive, 3-5 sessions per week
• Psychoanalytic therapy: Less intensive, 1-2 times per week
• Brief psychodynamic therapy: Time-limited, focused approach
• Mentalization-based therapy: Focus on understanding mental states
• Transference-focused therapy: For personality disorders

Effectiveness

Research supports psychodynamic therapy for:

• Depression
• Anxiety disorders
• Personality disorders
• Eating disorders
• Somatic symptom disorders
• Relationship difficulties

Meta-analyses, summarized in an influential 2010 review by Jonathan Shedler, report effect sizes broadly comparable to other established therapies. Some studies suggest gains are maintained or continue to grow after treatment ends, though the overall evidence base is smaller than for CBT. See also defense mechanisms.

Humanistic Therapies

Person-Centered Therapy (Rogerian Therapy)

Developed by Carl Rogers from the 1940s, this approach emphasizes the client's inherent capacity for growth and self-actualization.

Core Conditions

• Unconditional positive regard: Complete acceptance without judgment
• Empathy: Deep understanding of client's experience
• Congruence: Therapist authenticity and genuineness

Key Principles

• Clients have inherent wisdom and capacity for healing
• The therapeutic relationship is the primary healing factor
• Non-directive approach - client leads the session
• Focus on present experience and feelings
• Trust in the actualizing tendency

Gestalt Therapy

Developed by Fritz Perls, Laura Perls and Paul Goodman in the 1950s, Gestalt therapy (distinct from Gestalt psychology of perception) focuses on personal responsibility and experiencing the present moment.

Key Concepts

• Here and now: Focus on present awareness
• Contact: Authentic connection with self and others
• Figure and ground: What stands out vs. background
• Unfinished business: Unresolved past issues
• Personal responsibility: Owning one's experience

Techniques

• Empty chair: Dialogue with absent person or part of self
• Two-chair technique: Exploring internal conflicts
• Body awareness: Noticing physical sensations
• Experiments: Trying new behaviors in session
• Dream work: All parts of dream represent self
• I-statements: Taking ownership of experience

Existential Therapy

Focuses on universal human concerns and the search for meaning.

Core Themes

• Freedom and responsibility: Choosing one's path
• Death anxiety: Awareness of mortality
• Isolation: Fundamental aloneness
• Meaninglessness: Creating purpose in life
• Authenticity: Living according to values

Emotion-Focused Therapy (EFT)

Developed by Leslie Greenberg and colleagues, emotion-focused therapy integrates person-centered and Gestalt methods with research on emotion. A related couples therapy is described below.

Key Features

• Emotions as adaptive information
• Transformation through emotional experiencing
• Identifying primary vs. secondary emotions
• Emotional processing and regulation
• Good evidence for depression in individual therapy

Effectiveness of Humanistic Therapies

Meta-analyses of humanistic-experiential therapies, such as those by Robert Elliott and colleagues, report meaningful improvements, especially for depression and relationship difficulties, with fewer trials than for CBT. They are commonly used for:

• Depression and anxiety
• Relationship issues
• Self-esteem problems
• Personal growth and self-actualization
• Grief and loss
• Identity and existential concerns

Eye Movement Desensitization and Reprocessing (EMDR)

Overview

EMDR is a psychotherapy approach designed to help people process traumatic memories and reduce their emotional intensity through bilateral stimulation. It is widely used for trauma and PTSD.

How EMDR Works

Theoretical mechanisms include:

• Adaptive Information Processing: Helping brain process "stuck" memories
• Working memory taxation: Dual attention reduces memory vividness
• Interhemispheric communication and REM sleep mimicry: proposed explanations with little direct evidence

Of these, the working memory account has the most experimental support. Some researchers argue that the eye movements add little beyond the exposure to memories that EMDR shares with other trauma therapies, and this remains debated.

Eight Phases of EMDR

1. History and treatment planning: Assessment and goal setting
2. Preparation: Building resources and coping skills
3. Assessment: Identifying target memory and baseline measures
4. Desensitization: Processing with bilateral stimulation
5. Installation: Strengthening positive beliefs
6. Body scan: Checking for residual tension
7. Closure: Returning to calm state
8. Reevaluation: Checking progress in next session

Types of Bilateral Stimulation

• Eye movements: Following therapist's finger
• Tactile: Alternating taps or buzzers
• Auditory: Alternating tones in headphones

Effectiveness

EMDR is recommended for PTSD by the World Health Organization and several national guidelines, with outcomes broadly comparable to trauma-focused CBT. Research for other uses, such as complex trauma, phobias, depression and chronic pain, is growing but less established.

Perceived Advantages

• Does not require detailed verbal description of the trauma
• Little or no homework between sessions
• For single-incident trauma, treatment can be relatively brief

Acceptance and Mindfulness-Based Therapies

Acceptance and Commitment Therapy (ACT)

ACT helps people accept difficult thoughts and feelings rather than fighting them, while committing to values-based action. It draws heavily on mindfulness practices to build psychological flexibility.

Six Core Processes

• Contact with present moment: Mindful awareness
• Acceptance: Opening to experience without defense
• Cognitive defusion: Seeing thoughts as just thoughts
• Self-as-context: Observer self vs. conceptualized self
• Values: Identifying what truly matters
• Committed action: Values-guided behavior change

Key Techniques

• Metaphors and experiential exercises
• Mindfulness practices
• Values clarification exercises
• Defusion techniques (singing thoughts, silly voices)
• Willingness and acceptance exercises

Mindfulness-Based Stress Reduction (MBSR)

MBSR is an 8-week program developed by Jon Kabat-Zinn at the University of Massachusetts Medical School in 1979 for managing stress and chronic pain.

Core Components

• Body scan meditation
• Sitting meditation
• Mindful yoga
• Walking meditation
• Informal mindfulness practices
• Group discussions

Mindfulness-Based Cognitive Therapy (MBCT)

MBCT, developed by Zindel Segal, Mark Williams and John Teasdale, combines cognitive therapy with mindfulness to prevent depression relapse.

Key Features

• 8-week group program
• Focus on recognizing automatic patterns
• Decentering from thoughts
• Responding vs. reacting
• Early trials found it roughly halved relapse for people with three or more past episodes; a 2016 meta-analysis found a smaller but meaningful reduction in relapse risk

Compassion-Focused Therapy (CFT)

Developed by Paul Gilbert for people with high shame and self-criticism.

Three Affect Systems

• Threat system: Protection and safety
• Drive system: Resource seeking and achieving
• Soothing system: Affiliation and safeness

Key Practices

• Compassionate imagery
• Compassionate self-correction
• Soothing rhythm breathing
• Compassionate letter writing

Effectiveness

These approaches show efficacy for:

• Chronic pain
• Anxiety disorders
• Depression
• Substance use
• Eating disorders
• Stress-related conditions

Family and Couples Therapy

Emotionally Focused Therapy (EFT) for Couples

Emotionally focused couples therapy, developed by Sue Johnson and Leslie Greenberg and based on attachment theory, helps couples identify and change negative interaction patterns.

Three Stages

1. De-escalation: Identifying negative cycles
2. Restructuring: Creating new interactions
3. Consolidation: Reinforcing positive patterns

Effectiveness

A 1999 meta-analysis of early trials by Johnson and colleagues reported that around 70% of couples were no longer distressed after treatment. The trials were small, and later research has generally supported EFT as an effective couples therapy.

The Gottman Method

The Gottman Method, developed by John and Julie Gottman, draws on decades of observational research on couples' interactions. Its outcome research is smaller than its observational research.

Sound Relationship House

• Build love maps (knowing partner's world)
• Nurture fondness and admiration
• Turn towards instead of away
• Accept influence
• Solve solvable problems
• Overcome gridlock
• Create shared meaning

Structural Family Therapy

Developed by Salvador Minuchin, structural family therapy focuses on family organization and boundaries. See family systems therapy.

Key Concepts

• Family structure: Rules and patterns
• Subsystems: Parental, sibling, individual
• Boundaries: Clear, diffuse, or rigid
• Hierarchies: Power and authority
• Coalitions: Alliances within family

Strategic Family Therapy

Brief, problem-focused approach targeting specific issues.

Techniques

• Paradoxical interventions
• Reframing problems
• Prescribing the symptom
• Directives and homework

Bowenian Family Therapy

Developed by Murray Bowen, this approach focuses on multigenerational patterns and differentiation.

Core Concepts

• Differentiation of self
• Triangles in relationships
• Family projection process
• Multigenerational transmission
• Emotional cutoff

Narrative Family Therapy

Narrative therapy, developed by Michael White and David Epston, helps individuals and families rewrite problem-saturated stories.

Key Techniques

• Externalizing problems
• Identifying unique outcomes
• Re-authoring life stories
• Definitional ceremonies

Specialized Therapeutic Approaches

Internal Family Systems (IFS)

Internal Family Systems, developed by Richard Schwartz, views the mind as containing multiple sub-personalities or "parts." Its research base is still small.

Types of Parts

• Exiles: Vulnerable, wounded parts
• Managers: Protective, controlling parts
• Firefighters: Reactive, impulsive protectors
• Self: Core, compassionate essence

Somatic Experiencing

Somatic Experiencing, developed by Peter Levine, is a body-oriented approach to trauma. It is popular, but its research base is small and its theory is not widely tested.

Key Principles (as described by the model)

• Trauma responses involve the body as well as memory
• Titration (working with small amounts of activation)
• Pendulation (moving between distress and calm)
• Completing interrupted defensive responses
• Building resilience

Interpersonal Therapy (IPT)

Interpersonal therapy, developed by Gerald Klerman and Myrna Weissman, is a structured, time-limited therapy for depression with strong research support.

Four Problem Areas

• Grief and loss
• Role disputes
• Role transitions
• Interpersonal deficits

Schema Therapy

Schema therapy is an integrative approach for personality disorders and chronic issues.

Core Elements

• Early maladaptive schemas
• Schema modes (emotional states)
• Limited reparenting
• Experiential techniques
• Cognitive and behavioral strategies

Solution-Focused Brief Therapy (SFBT)

Solution-focused brief therapy, developed by Steve de Shazer and Insoo Kim Berg, is a future-focused, goal-directed approach.

Key Techniques

• Miracle question
• Scaling questions
• Exception finding
• Compliments and acknowledgment
• Focus on solutions, not problems

Motivational Interviewing (MI)

Motivational interviewing, developed by William Miller and Stephen Rollnick, is a collaborative approach for exploring ambivalence about change, with good evidence in substance use and health behavior.

Core Principles

• Partnership, acceptance, compassion and evocation (the "spirit" of MI)
• Four processes: engaging, focusing, evoking and planning
• Eliciting the person's own reasons for change
• Supporting self-efficacy

Earlier editions framed the principles as expressing empathy, developing discrepancy, rolling with resistance and supporting self-efficacy.

Art and Expressive Therapies

Using creative expression for healing.

Types

• Art therapy: Visual arts
• Music therapy: Creating or listening
• Dance/movement therapy: Body expression
• Drama therapy: Role play and performance
• Poetry therapy: Writing and reading
• Play therapy: For children

Choosing the Right Therapy

Factors to Consider

Your Specific Concerns

• Depression: CBT, IPT, psychodynamic, ACT
• Anxiety and OCD: CBT, exposure therapy, ERP, ACT
• Trauma/PTSD: Trauma-focused CBT (such as CPT and prolonged exposure), EMDR; body-based approaches have weaker evidence
• Relationship issues: Emotionally focused couples therapy, integrative behavioral couple therapy, Gottman Method
• Personality disorders: DBT, schema therapy, psychodynamic
• Eating disorders: CBT-E, DBT, family-based treatment
• Substance use: MI, CBT, DBT, 12-step facilitation
• Chronic pain: ACT, MBSR, CBT

Your Preferences

• Structured vs. open-ended: CBT/DBT vs. psychodynamic/humanistic
• Present vs. past focus: CBT/solution-focused vs. psychodynamic
• Directive vs. non-directive: CBT/behavioral vs. person-centered
• Individual vs. group: Consider both options
• Short-term vs. long-term: Brief therapies vs. psychoanalytic

Practical Considerations

• Availability: What's offered in your area
• Cost and insurance: Coverage varies by approach
• Time commitment: Weekly vs. intensive programs
• Therapist expertise: Specialized training matters

Evidence-Based Practice

Look for therapies with research support for your specific concern. However, remember that the therapeutic relationship is often more important than the specific approach.

Integrative and Eclectic Approaches

Many therapists integrate multiple approaches:

• Integrative therapy: Theoretical integration of approaches
• Eclectic therapy: Using techniques from various schools
• Common factors approach: Focus on universal healing elements

Questions to Ask Potential Therapists

• What is your therapeutic approach?
• Do you have experience with my specific concerns?
• What can I expect from sessions?
• How do you measure progress?
• What is the typical duration of treatment?
• Do you assign homework?
• How do you handle crises between sessions?

When to Consider Changing Approaches

• No improvement after 3-4 months
• Poor fit with therapist style
• Approach doesn't resonate with you
• New issues emerge requiring different expertise
• You've plateaued in progress

The Importance of Fit

Research consistently finds that the quality of the therapeutic relationship is one of the strongest predictors of positive outcomes. For practical next steps, see how to find a therapist. A good therapist of any orientation who you connect with is likely to be more helpful than a highly trained therapist in your "ideal" modality with whom you don't feel comfortable.