Understanding Different Approaches

Why approaches matter less than you think

If you have been researching therapy, you have probably come across a confusing list of abbreviations: CBT, EMDR, psychodynamic, person-centred, integrative. It can feel like you need to choose the right one before you even start.

A 2018 meta-analysis found a consistent link between the working relationship and the outcome of therapy, whatever the approach. That said, understanding the broad differences can help you feel more confident about what to expect.

Source: Flückiger et al. 2018

The main approaches

Cognitive behavioural therapy (CBT)

CBT focuses on the connection between your thoughts, feelings and behaviours. It is structured and short-term, normally 5 to 15 sessions, with practical exercises between them. Your therapist will help you identify unhelpful thought patterns and develop strategies for changing them.

The NHS lists depression, anxiety, OCD and phobias among the conditions CBT is used to treat. If you prefer a practical, goal-oriented approach, CBT may suit you well. Read more about CBT.

Person-centred therapy

Person-centred therapy, developed by Carl Rogers, is built on the idea that you already have the resources to understand yourself and grow. Your therapist provides a warm, non-judgmental space and follows your lead rather than directing the conversation.

This approach works well if you want to explore your feelings at your own pace without a fixed agenda. There is no homework and no set number of sessions. Read more about person-centred therapy.

Counselling

Counselling is a widely offered talking therapy in the UK. You meet a trained counsellor and talk through what is troubling you, and they listen without judging or directing. Much counselling grows from the person-centred tradition.

It suits a bereavement, a relationship ending or a stretch of life that has become too much. There is no set programme and no homework. Read more about counselling.

Psychodynamic therapy

Psychodynamic therapy explores how your past experiences, particularly early relationships, shape your present feelings and behaviours. It tends to be longer-term and less structured than CBT.

You might find this approach helpful if you notice repeating patterns in your relationships or reactions that feel disproportionate to the situation. It involves looking beneath the surface. Read more about psychodynamic therapy.

Integrative therapy

Many practitioners describe themselves as integrative, meaning they draw on multiple approaches and tailor their methods to what works best for you. Rather than following one model rigidly, an integrative therapist adapts.

It is common in UK private practice. If you are unsure what you need, an integrative practitioner can be a good starting point. Read more about integrative therapy.

Humanistic and existential therapy

Humanistic therapy focuses on your potential for growth and self-fulfilment. Existential therapy explores questions of meaning, freedom and responsibility. Both encourage you to examine your life as a whole rather than focusing on specific symptoms.

These approaches suit people who are drawn to deeper questions about identity and purpose rather than symptom relief alone. Read more about humanistic therapy and existential therapy.

Specialised approaches

Some approaches were built for specific conditions:

• EMDR for trauma and PTSD: uses bilateral stimulation to work through traumatic memories, and NICE recommends it for adults with PTSD
• DBT for emotional regulation: combines CBT with mindfulness techniques
• ERP for OCD: a structured approach to gradually facing fears. NICE names it in its OCD guideline
• MBCT for depression that keeps coming back: a course NICE names for preventing relapse in recurrent depression

If you have a specific diagnosis, your practitioner's training in the relevant specialism matters more than their general approach.

Sources: NHS: CBT overview, NICE NG116, NICE CG31, NICE NG222

More ways of working

Each of these has its own page. They sit in the same groups as the full list of approaches.

Changing thoughts and habits

• Acceptance and commitment therapy (ACT): make room for hard thoughts and feelings, and act on what matters to you
• Behavioural therapy and behavioural activation: change what you do, one planned step at a time, and let your mood follow
• Compassion-focused therapy (CFT): quieten a harsh inner critic and build a kinder, steadier voice

Understanding the past and its patterns

• Psychoanalytic therapy and psychoanalysis: deep, open-ended work with the unconscious, from weekly sessions to psychoanalysis
• Jungian therapy: finding meaning in dreams, images and symbols, in the tradition of Carl Jung
• Relational therapy: working through old patterns in the relationship with your therapist
• Schema therapy: changing deep patterns that formed early in life, and meeting the needs behind them
• Cognitive analytic therapy (CAT): mapping the patterns you keep repeating, in a set number of sessions
• Transactional analysis (TA): seeing the Parent, Adult and Child in how you talk and relate to people
• Internal family systems (IFS): getting to know the different parts of you, including the ones that protect you

Growth, meaning and the whole person

• Existential therapy: facing meaning, freedom and mortality with a therapist beside you
• Gestalt therapy: noticing what you feel, think and do, here and now
• Narrative therapy: separating you from the problem, so a new story can grow
• Transpersonal therapy: therapy that makes room for spiritual experience and questions of meaning

Trauma and the body

• Somatic therapy: noticing what your body does under stress, and working with it as you talk

Couples, families and relationships

• Family and systemic therapy: looking at the patterns between people, with whoever matters in the room
• Interpersonal therapy (IPT): a set course that links how you feel to your relationships and life changes
• Psychosexual therapy: talking therapy for sex and intimacy, with a GP check first where needed

Creative and outdoor therapies

• Art therapy: making images alongside talking, with a therapist who looks at them with you
• Music therapy: playing and listening with a therapist, where talking is not the main route
• Dramatherapy: working through role, story and movement rather than talking straight at it
• Dance movement psychotherapy: using movement as well as talk, with a therapist who watches how you move
• Ecotherapy and nature-based therapy: therapy that happens outdoors, on a walk, in a garden or alongside animals

General, brief and other kinds of help

• Solution-focused brief therapy (SFBT): a short, forward-looking therapy that builds on what already works for you
• Motivational interviewing (MI): a way of talking through being in two minds, without being pushed either way

Beyond talking therapy

Two other kinds of help sit alongside therapy on ViaCara, and neither is a treatment for a mental health condition.

• Coaching works forward, on a goal you have chosen and the actions that get you there. It suits a change you want to make and keep, and it is not built for working through the past
• Hypnotherapy uses relaxation techniques to try to change a habit or a way of thinking. The advertising code accepts that it can help relieve anxiety and aid sleep, and NICE says referral for it should be considered for irritable bowel syndrome that has not responded to medicines after 12 months

If low mood, anxiety or something that happened is what holds you back, start with a therapist. Each of those two pages says where its own limits are.

Sources: CAP: hypnotherapy, NICE CG61

How to think about choosing

You do not need to become an expert in therapeutic modalities. A few practical questions can guide you:

• Do you want structure or openness? CBT is structured with exercises. Person-centred therapy follows your lead
• Are you focused on a specific problem or exploring broadly? Problem-focused work suits CBT or solution-focused therapy. Broader exploration suits psychodynamic or humanistic approaches
• Do you have a specific diagnosis? Some conditions have evidence-based treatments that are worth prioritising
• What feels right? Your gut feeling about a practitioner during an initial consultation is a valid signal

The most important thing is that you feel comfortable with the person sitting across from you. The approach is the framework; the relationship is the work.