Therapy Types and Modalities
Whether you are looking for a therapist for the first time or trying to make sense of the treatment you are already receiving, understanding the therapeutic approach of a therapist is critical. It is easy to treat it as background detail, but the type of therapy being practiced by a therapist has direct implications for what sessions feel like, what role you are expected to play, how long treatment is likely to run, and whether the approach is a good fit for your specific needs.
Why therapy approach matters
No single form of therapy works best for everyone. However, effective approaches to therapy are thought to share certain common factors, such as a therapist who treats the client with empathy, a rapport between the therapist and client (sometimes referred to as the “therapeutic alliance”), and agreement about the goals of therapy. For many kinds of distress, different types of therapy may have remarkably similar positive effects if there is a strong therapeutic alliance.
Nevertheless, knowing the tools your therapist uses and how those tools can help you achieve your goals is a key part of actively engaging in therapy. A therapist who is not clear about their approach may be signaling that they do not use evidence-based methodologies. Even if a therapist draws from multiple approaches, understanding this can strengthen your buy-in and trust in the therapeutic process.
Common types of therapy
Therapists draw on a range of approaches, some broadly applicable and others developed with particular difficulties in mind. Common therapeutic approaches include:
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) involves challenging the negative and irrational thoughts that lead to dysfunctional behaviors and perpetuate distress. Therapists trained in CBT aim to help clients learn and practice ways of dealing with negative automatic thought patterns in more adaptive ways.
Psychodynamic therapy
Psychodynamic therapy focuses on helping clients achieve a better understanding of themselves and their inner conflicts as a way to alleviate distress and improve relationships. A therapist using a psychodynamic approach may draw connections between a patient’s current feelings and past experiences and will identify common patterns in one’s thoughts, experiences, or relationships.
Dialectical Behavioral Therapy (DBT)
Dialectical behavioral therapy (DBT) is a structured, skills-based therapy that focuses on helping individuals manage intense emotions, tolerate distress, and improve relationships. Treatment often includes a combination of individual therapy and group skills training, with an emphasis on practicing skills between sessions. DBT teaches four core skill areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy (ACT) focuses on increasing your ability to engage with difficult thoughts and emotions without being dominated by them and while continuing to act in ways that align with one’s values. Rather than trying to eliminate distress, ACT helps individuals change their relationship to internal experiences.
For a full list of different approaches to therapy, see Types of Therapy.
The client’s role in different therapy types
One of the most important differences between therapy types is how much direction comes from the therapist versus the client.
More structured therapy (for example, CBT, DBT):
- Therapist leads the conversation
- Sessions follow a clear plan
- Active skill-building
- Better for clients who want concrete tools and a clear sense of progress toward defined goals
Less structured therapy (for example, Psychodynamic therapy):
- Client guides the conversation
- Therapist listens and interprets patterns
- Focus on insight rather than specific techniques
- Better for clients who want to explore emotional patterns, understand these patterns more deeply, and work through longstanding difficulties at their own pace
Practical considerations: Session frequency and format
Therapeutic approach has direct implications for logistics, and these matter when weighing your options. Practical considerations include:
Session frequency
CBT and similar structured approaches are typically short-to-medium term, often between 12 and 20 sessions, with a relatively defined endpoint. By contrast, psychodynamic therapy is more often open-ended, with no predetermined number of sessions, and may run for a year or longer depending on what is being addressed. If time or cost are concerns for you, shorter-term CBT or similar structured approaches may be a better fit.
Session format
Most forms of therapy can be delivered remotely (via online video or phone call) by a therapist. This can improve access to therapy and offer more flexibility if you have scheduling constraints. However, some therapy types like exposure therapy or Eye Movement Desensitization and Reprocessing (EMDR) may benefit from in-person sessions due to the impact that direct therapist support and observation can have in the therapeutic process for these therapy types.
Finding the right fit
When you’ve found a potentially good fit, contact the therapist to schedule an initial consultation. This is a great time to ask questions about the therapist’s approach. Common questions to ask a new therapist include:
- What approach do you primarily use?
- What evidence supports this approach for my concern?
- What would sessions look like week-to-week?
Being knowledgeable about therapy types can help you become more informed and ready to start the therapy process.
Use the Psychology Today Directory to find a therapist in your area. You can use the Types of Therapy filter option to find a therapist who practices a specific approach, or filter by Specialties to find a therapist who specializes in your specific condition or concern.
