Psychotherapies: which one for what
- Topic
Talking therapies are not all the same: each has its own idea of what keeps a problem going and the problems where it works best.
What it is
A psychotherapy is a structured, planned treatment that uses the relationship and conversation between a trained clinician and a patient to change thoughts, emotions and behavior. The main families are cognitive-behavioral, psychodynamic, humanistic, interpersonal, family and group approaches. They differ in what they target (present thoughts and habits, unconscious conflict, relationships, the family system), and the best evidence for each lies with particular conditions. Choosing well also depends on the patient's goals, preference and access.
Key facts
- Across therapies, the quality of the therapeutic alliance (agreement on goals and tasks plus a trusting bond) is one of the strongest predictors of benefit.
- Evidence-based therapies are usually manualized and time-limited, which is what allowed them to be tested in trials.
- Humanistic, client-centered therapy rests on empathy, genuineness and unconditional positive regard; it shaped the listening style of most other therapies.
- Behavior therapies come straight from learning theory: exposure and systematic desensitization (classical conditioning), contingency management and token economies (operant conditioning).
- Motivational interviewing is a brief, collaborative style to resolve ambivalence; it is used before and alongside other treatments, especially for substance use.
Main psychotherapies, their core idea and where the evidence is strongest
| Therapy | Core idea | Best-supported uses |
|---|---|---|
| Cognitive behavioral therapy (CBT) | Thoughts, feelings and behavior feed each other; change unhelpful thoughts and habits in the present | Depression, generalized anxiety, panic, social anxiety, bulimia |
| Exposure and response prevention | Facing the feared cue without escape or rituals until fear fades (extinction) | OCD, specific phobias, panic |
| Trauma-focused CBT and exposure-based therapies | Process the traumatic memory and reduce avoidance in a safe setting | PTSD |
| Contingency management | Reward verified abstinence or goals with prompt, tangible reinforcers | Stimulant use disorder, other substance use |
| Dialectical behavior therapy (DBT) | Balance acceptance with change; teach emotion and distress skills | Borderline personality disorder, self-harm |
| Interpersonal therapy (IPT) | Mood improves when grief, role disputes and role transitions are worked through | Depression, perinatal depression |
| Family-based treatment | Parents temporarily take charge of eating; the family is the resource, not the cause | Adolescent anorexia nervosa |
| CBT for insomnia | Re-link bed with sleep and consolidate sleep; correct sleep-related worries | Chronic insomnia |
| Motivational interviewing | Draw out the patient's own reasons for change; roll with ambivalence | Alcohol and other substance use, adherence |
| Supportive therapy and crisis intervention | Restore coping and safety; strengthen what already works | Adjustment problems, acute crises |
| Psychodynamic therapy | Insight into unconscious patterns and their repetition in relationships | Depression (time-limited forms), personality problems |
Clinical notes
- A referral is more useful when it names the therapy (for example, exposure-based CBT for panic) rather than just ‘therapy’.
- Psychotherapy is a treatment with expected benefits and possible adverse effects; progress is measured, for example with symptom scales at regular sessions.
Test yourself
Think of the answer, then tap the question to see it.
Which psychotherapy has the broadest evidence base across depression and anxiety disorders?
Cognitive behavioral therapy (CBT).
What is the first-line psychological treatment for an adolescent with anorexia nervosa?
Family-based treatment, in which parents temporarily take charge of the adolescent's eating.
Which therapy was designed for borderline personality disorder with recurrent self-harm?
Dialectical behavior therapy (DBT).
What is the first-line treatment of chronic insomnia?
Cognitive behavioral therapy for insomnia (CBT-I), ahead of hypnotic medication.
Which behavioral approach has strong evidence for stimulant use disorder?
Contingency management: prompt, tangible rewards for verified abstinence.
Elsewhere in DurgiPedia
Connections
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Psychotherapies (National Institute of Mental Health (NIMH), 2024); Depression (National Institute of Mental Health (NIMH), 2024).
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