Understanding Different Types of Psychotherapy and Their Uses

Psychotherapy Comes in Different Types

In everyday speech, psychotherapy is often shortened to “therapy” and treated as a generic service — as though everyone’s psychotherapy should look the same. And then, to add to the confusion, the public learns that certain terms or buzzwords separate “good” types of psychotherapy from “bad.”

This is a big misunderstanding.  In reality, there are different types or schools of psychotherapy. No one type is best. Each works best for certain kinds of problems and certain kinds of people. All mainstream schools of psychotherapy are “good” when matched carefully to the person seeking help.

Think of the world of psychotherapy as a tree. There are two main limbs, with smaller branches that grow from them.

Exploratory or Depth Psychotherapy

Exploratory/depth psychotherapy is the original kind of psychotherapy and it is based on the assumption that emotional and relationship difficulties arise from underlying feelings that are hard to face. These underlying feelings often affect one’s life broadly: across different relationships, or from one job to the next.

Because the feelings are “underlying,” not on the surface, the emotional difficulties often seem ill-defined and hard to pin down. For this reason, depth therapy is best suited for vague but troubling emotional discomfort, and for issues that arise repeatedly in different circumstances, often across multiple generations

The therapeutic relationship is set up so that the client feels safe enough to speak in an uncensored way. This allows “unacceptable” feelings to arise. Also, since the same dynamics arise across relationships, they may appear in the therapy relationship itself. This allows real-time observation and appreciation of the client’s emotional struggles.

When formerly hidden feelings emerge, the client naturally deals with them more thoughtfully. People often improve in depth psychotherapy without conscious effort to change anything specific.

There are different types or branches of depth psychotherapy. Some emphasize bringing underlying feelings to the surface (“making the unconscious conscious”). Others discuss the mental models of “self and other" the client uses. Still others rely more on the healing effect of the therapist as an empathic listener. These branches tend to overlap; they’re more like emphases instead of distinct schools.

Depth psychotherapy has been around for decades and is well-studied. It is proven effective for a wide variety of emotional and relationship issues.

Depth psychotherapy has no pre-set agenda, no exercises or homework assignments. Those who wish to get to the root of their problems and who appreciate the complexity beneath the surface of their lives will find depth psychotherapy most suited to them. On the other hand, it may be frustrating for clients who seek a standardized formula or a series of defined steps to feel better. 

CBT and Similar Psychotherapies

Cognitive behavioral therapy (CBT) takes a different approach. It assumes that thoughts precede feelings, such that changing how one thinks changes how one feels. Because CBT doesn’t deal with underlying feelings, this approach is best for conscious problems that are easier to name: low mood, anxiety, insomnia, and so forth.

In contrast to depth psychotherapy, CBT is more standardized, agenda-driven, and concrete. CBT therapists identify the client’s troubling thoughts or beliefs, and suggest emotionally healthier ones to replace them. Feelings change as a result. This is a learning process for the client and takes practice. 

There are often homework assignments. For example, clients may keep “thought records” at home that are later reviewed in the therapy sessions.

CBT is best for clients who wish to focus more narrowly on symptoms without exploring their roots, and for those who prefer concrete steps over ambiguity. On the other hand, CBT may be frustrating or unhelpful if the source of the client’s emotional problems is outside his or her awareness — it doesn’t seek to “get to the root” of these problems.

CBT is often mistakenly considered the “gold standard” therapy because it is easy to study and to show positive effects on specific concrete symptoms. It’s important to realize that such studies are only relevant if your own problems are among the ones studied, and are equally concrete and specific.

The general principles of CBT have been adapted into other distinct branches of psychotherapy, often known by their two- or three-letter abbreviations. Usually, these have added mindfulness and similar calming or meditative practices.

A good example is dialectical behavior therapy (DBT), originally designed to treat those with chronic suicidal or self-destructive impulses. A full treatment protocol of DBT includes individual and group sessions, a crisis line to talk between sessions, and homework assignments. Some “DBT” does not use this full protocol. Other examples include acceptance and commitment therapy (ACT) and behavioral activation (BA).

How To Choose a Type of Psychotherapy

Since all mainstream psychotherapy is research-proven and evidence-based, it isn’t a matter of finding “good” therapy and avoiding “bad.” The best type of psychotherapy is the kind that best fits you and your reasons for seeking therapy in the first place.

This information is brought to you by PsiAN, a nonprofit organization of thousands of mental health professionals and related organizations and agencies. Our work has shown that there’s an imbalance in the public’s perception of the two main “limbs” of psychotherapy outlined above. Depth psychotherapy is under-appreciated, while CBT is often considered the “best” therapy.

It’s not our aim to slam CBT. It can be very helpful. But it’s not “best,” and it’s not even the most scientific or evidence-based. Give both major types of psychotherapy a fair hearing, and come to your own conclusion about what would be best for you.