Different Types of Therapy: Choosing the Right Treatment

Types o f TherapyThe importance of mental health is becoming a widely accepted aspect of human development and wellbeing.

According to the National Association of Mental Illness (2021), 20.6% of US adults experienced mental health issues in 2019. Also in 2019, 19.2% of adults in the United States received some form of mental health treatment (Terlizzi & Zablotsky, 2020).

While there is no “one size fits all” treatment for improving mental health and wellbeing, there is a plethora of options available.

Choosing the right one can seem overwhelming and tedious. A helpful place to start is understanding the basic approaches and treatments available and how well they fit an individual’s unique needs. So, let’s start by looking at the basics.

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What Are the Different Therapy Modalities?

Different types of therapy use a variety of modalities to treat clients. Modalities are essentially the tools a therapist or coach uses to help individuals reach their goals. The theoretical framework or approach often determines which modalities are appropriate.

For example, psychoanalytic therapy will use talk therapy, dream work, and catharsis techniques. Dialectical Behavior Therapy (DBT) will use mindfulness and psychoeducation.

Other types of modalities include somatic experiences, art therapy, play therapy, drama therapy, family therapy, yoga therapy, sand-tray therapy, and imago therapy just to name a few.

The most popular types of psychotherapy might use a variety of these modalities throughout the treatment process.

 

4 Popular Types of Psychotherapy

group-therapyThere are many different approaches to psychotherapy, but four of the most popular include the following:

 

1. Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) is an evidence-based treatment founded on the premise that our thoughts control our emotions and behavior (National Institute of Mental Health, 2021).

It is a short-term, goal-oriented therapy that examines the link between thoughts, emotions, and behavior. In CBT sessions, clients will learn how to recognize cognitive distortions or “thinking traps,” such as all-or-nothing thinking, catastrophizing, and making faulty assumptions.

Once the negative thought pattern is identified, clients practice more rational and positive ways to view situations and experiences. Most CBT practitioners include a homework component so that clients can practice identifying and changing thoughts in real-life personal situations.

 

2. Dialectical Behavior Therapy

Dialectical Behavior Therapy is a form of CBT that aims to give people skills to regulate emotions, improve relationships, handle stress, and live mindfully.

It was originally created to treat people with borderline personality disorder, but it is now used to help people with a wide range of mental conditions (McKay, Wood, & Brantley, 2019). DBT teaches clients that our experiences are real, but radical acceptance, distress tolerance skills, and mindfulness can help us handle negative feelings, conflict, and impulsive tendencies.

DBT usually also has a homework component and can be done in individual or group sessions.

 

3. Psychodynamic Therapy

Psychodynamic Therapy is one of the oldest approaches to therapy and emphasizes how past and present life events and relationships affect current feelings, relationships, and choices.

The goal is to help clients acknowledge and understand negative feelings, repressed emotions, and resolve internal psychological conflicts.

It is a popular treatment for people with depression and works to uncover memories, experiences, and dreams that helped to shape the client’s life and relationships.

 

4. Humanistic/Experiential Therapy

Humanistic/Experiential Therapy focuses on an individual’s nature rather than the collection of behaviors that make up a psychological category. It involves a holistic approach to emphasize the whole person and their ability to grow, heal, and find self-actualization through self-exploration.

This approach includes two popular techniques/modalities:

  1. Gestalt Therapy helps clients focus on “here and now” feelings and experiences rather than root causes. This approach uses experiential techniques like role-play, physical movement, and reenacting events to arouse emotions and understand how they happen.

  2. Person-Centered Therapy is based on the idea that individuals are capable of deciding what they want to explore and how they want to do it. For this reason, it is also known as a non-directive approach, where a therapist provides a supportive environment to investigate identity, feelings, experiences, and emotions to encourage growth and self-realization.

 

4 Group Therapy Modalities

Group therapy provides a great opportunity for people experiencing similar issues to join together to resolve them. Some of these issues may include relationship problems, medical issues, depression, anxiety, anger, trauma, addiction, and life transitions.

Group therapy can be defined as a meeting of two or more people with a common therapeutic purpose or to achieve a common goal (Center for Substance Abuse Treatment, 1999). There are a few different approaches or modalities that group formats can use:

  1. Process-sensitive groups are directed by analytical theory. This format examines the unconscious processes of the group as a whole and helps individuals see themselves more clearly. The group as a whole views healing as an extension of the individuals within the group.

  2. A directive approach provides structured goals and therapist-directed interventions that help individuals change in desired ways. It is commonly used by alcohol and drug counselors.

  3. Heterogeneous groups include members who have a variety of diagnoses or mental health issues. The diverse make-up creates more complexity and provides opportunities for a range of relationships, which can benefit group members.

  4. Homogeneous groups, on the other hand, include group members with similar issues, goals, and backgrounds. These groups create a sense of cohesion and safety much more quickly, which may be useful in time-limited group interventions.

No matter what modality a group format takes, group therapy can be conducted within the context of nearly any theoretical framework that individual therapy can (Center for Substance Abuse Treatment, 1999).

It is important for the group leader or therapist to use the framework and modality most appropriate for group members’ needs and goals.

 

Treating Depression and Anxiety

Motivational Interviewing QuotesAnxiety disorders are the most common mental health issue in the United States, affecting 40 million adults (18.1% of the population) each year (Anxiety and Depression Association of America, n.d.).

Many people with anxiety also seek treatment for depression, and nearly half of individuals with depression are also diagnosed with anxiety (Anxiety and Depression Association of America, n.d.).

As the statistics show, anxiety and depression are intricately connected. Depression is often triggered by a heightened state of anxiety, which leads to feelings of hopelessness and overwhelm, which creates more anxiety and stress – and the cycle continues.

One of the most effective methods of treating both anxiety and depression is Cognitive-Behavioral Therapy. Our patterns of thought can change through neuroplasticity and the power of cognition (Schwartz & Begley, 2003). Neuroplasticity is essentially the ability of the brain to change, influencing our feelings, moods, actions, and the way we live.

Behavioral activation is another method of treating anxiety and depression (Pittman & Karle, 2015). Behavioral activation includes things like exercise, yoga, talking to friends, and taking part in self-care activities.

Some individuals with depression and/or anxiety may be unmotivated or afraid to participate in activities that are good for them. By forcing themselves to take action, clients may feel better physically and mentally and can break the cycle.

Exposure therapy is an evidence-based approach for treating anxiety that exposes clients to situations or objects that trigger anxiety or fear (Pittman & Karle, 2015). Through repeated exposure, clients can feel an increased sense of control.

Systematic desensitization is part of exposure therapy. It is a step-by-step approach to challenge fears gradually through exposure. This helps clients build confidence slowly and master skills for controlling panic. It involves learning relaxation skills, creating a list of scary situations, and working through steps.

While anxiety and depression are two of the most common mental health issues, many forms of psychotherapy have demonstrated efficacy in alleviating symptoms. Behavioral therapy includes some of the most effective treatments for anxiety and depression.

 

Types of Behavioral Therapy

Behavioral therapy focuses on the role of learning in developing both normal and abnormal behaviors. It is a term used to describe a range of techniques that reinforce desirable behaviors and eliminate unwanted ones (Staddon & Cerutti, 2003). The premise is that if old learning led to the development of a problem, new learning can fix it.

CBT, DBT, and exposure therapy are all types of behavioral therapy. Another is applied behavior analysis, which uses operant conditioning to shape and modify problematic behaviors.

Rational Emotive Behavior Therapy is similar to CBT in that it helps clients identify negative or destructive thoughts and emotions. They can then actively challenge thoughts and replace them with more rational and realistic ones.

Social learning theory focuses on how people learn through observation. It is based on the idea that behavior change can occur through watching others being rewarded or punished.

 

4 Types for Couples Therapy

Couples therapy offers a powerful tool for increasing intimacy, improving communication, and building trust.

There are many types of couples counseling to choose from depending on individual preferences and relationship goals (Bonior, 2017).

  1. The Gottman method is a research-backed approach to therapy that focuses on shared relationship histories, exploring areas of disagreement, identifying various triggers, discovering shared values, and learning tools to help manage conflict (Gottman Institute, n.d.).

The Gottman method hones in on the “four horsemen” that destroys relationships: criticism, contempt, defensiveness, and stonewalling.

  1. Discernment counseling was developed for conflicted couples where one partner wants to save the relationship and one wants to end it.

It is a short-term approach designed to bring clarity to both partners by considering all options and making an ultimate decision on the fate of the relationship.

  1. Emotion-focused therapy is another well-researched and tested form of couples therapy.

In this type of counseling, each partner will share specific problems in the relationship and work to identify, explore, and make sense of underlying emotions that contribute to the problem. By addressing more vulnerable emotions, partners can access deeper emotions and find connection.

  1. Imago relationship therapy sees a couple’s issues as a result of unmet childhood needs and unhealed wounds.

These become sensitivities, conflicts, or pain points. The three-step process involves mirroring, validating concerns, and expressing empathy.

Each of these forms of couples therapy has scientific evidence to support its efficacy for improving relationships.

 

For Treating Trauma

Post-traumatic stress disorder (PTSD) tends to be a chronic condition associated with debilitating physical illness such as heart disease, type II diabetes, gastrointestinal disorders, premature aging, and a greater likelihood of mood, anxiety, and substance use disorders (Goldstein et al., 2016).

The American Psychological Association recommends the use of evidence-based treatments for PTSD. These treatments include Cognitive Processing Therapy, Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), Stress Inoculation Training, and Eye Movement Desensitization and Reprocessing Therapy (EMDR).

 

Cognitive Processing Therapy

Cognitive Processing Therapy is an exposure-based form of CBT that uses 12 sessions to treat clients with rape-related PTSD and veterans and military personnel (Resick & Schnicke, 1992).

The exposure component of therapy is a written account of the trauma. Most of therapy is spent analyzing the meaning of the traumatic event and training the client to challenge distorted beliefs about the event, themselves, and the world using Socratic questioning.

 

Trauma-Focused Cognitive-Behavioral Therapy

TF-CBT is a component-based hybrid approach of trauma-sensitive interventions; cognitive-behavioral principles; and attachment, family, empowerment, and humanistic theoretical models.

It includes 12–18 sessions that address traumatic events and resolve PTSD symptoms, and it has been shown to be particularly helpful for children and adolescents (Cohen, Mannarino, & Deblinger, 2006).

 

Stress Inoculation Training

Stress Inoculation Training was developed to reduce anxiety and manage stress while learning relaxation and coping skills (Meichenbaum, 1985). As an instructional coping skill approach, it also facilitates new adaptive responses to trauma-related stimuli using muscle relaxation, breath control, role-play, thought stopping, and guided self-dialogue.

 

Eye Movement Desensitization and Reprocessing Therapy

EMDR emphasizes the brain’s role in information processing and has been the subject of extensive research (Shapiro, 2017).

It conceptualizes insufficiently processed memories of trauma. The practitioner directs the client to move their eyes from side to side simultaneously (or practice another form of repetitive behavior) to desensitize the traumatic memory and reprocess it to something more adaptive.

 

A Look at Children’s Therapy

Age is an important factor to consider when selecting the best therapeutic options.

Play therapy may be an appropriate choice for children ages 4–12. It is a form of treatment that helps children and families express emotions, improve communication, and solve problems (Cohen et al., 2006).

It may include specific activities such as drawing family scenes, using puppets to act out events, creating scenes in a sand tray (sand-tray therapy), or playing therapeutic board games. Research has shown that play therapy can buffer the effects of trauma and loss, reduce anxiety and depression, help with behavioral issues, and improve a child’s ability to manage social and academic difficulties (Cohen et al., 2006).

Also read our article on Therapy for Kids and Choosing the Right Child Therapist.

 

How to Choose the Right Treatment

Choosing the right form of therapy can seem like an overwhelming and daunting task. The most important thing to consider is how well the type of treatment meets individual goals and preferences.

Identifying specific client goals is the first step. This motivation and goal-setting worksheet is a great place to start.

Clarifying specific goals and motivation for therapy can lead clients to the most appropriate treatment modalities.

For example, if an individual wants to decrease their levels of anxiety or get rid of a phobia, looking for a therapist who specializes in exposure therapy and anxiety disorders would be a good place to start.

If a couple is torn between staying together and splitting up, a couples therapy approach of discernment counseling might be the best option.

These questions and goals are ideal after considering practical issues such as whether insurance will cover mental health costs, what is affordable, and what services are offered in the client’s geographical area. A doctor or professional in the field may be able to provide specific referrals.

 

A Take-Home Message

Once goals and practical therapy options are identified, many therapists and coaches will offer a free consultation or more information before scheduling an appointment.

During this time, potential clients can ask questions and gain a better understanding of therapist fit, length of expected treatment, and specific techniques that will be used.

Therapy and mental health treatment should be a safe, systematic, gradual process to reaching wellness goals (Mental Health America, n.d.).

With the prevalence of mental health issues across the globe and the increased acceptance and availability of online counseling services, people have a lot of choices.

Making informed and calculated decisions regarding therapy can mean the difference between suffering and flourishing.

And everyone deserves the chance to live their best life.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.

If you wish for more, our Positive Psychology Toolkit© contains over 370 science-based positive psychology exercises, interventions, questionnaires, and assessments for practitioners to use in their therapy, coaching, or workplace.

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About the Author

Dr. Melissa Madeson, Ph.D., believes in a holistic approach to mental health and wellness and uses a person-centered approach when working with clients.   Currently in full-time private practice, she uses her experience with performance psychology, teaching, and designing collegiate wellness courses and yoga therapy to address a range of specific client needs.

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