Which Psychotherapy Style is Right for Me?

by Anna Glezer, MD

Authored by: Anna Glezer, MD

Which Psychotherapy Style is Right for Me?

Therapy is one of the gold standard treatments for so many different mental health concerns. It's valuable whether you have a condition like depression or anxiety, if you're struggling with life transitions or challenges, or even if you'd like to learn more about yourself and improve your relationships. This article is to help you learn about the different types of psychotherapy styles out there. 

Why is a Psychiatrist Talking about Therapy?

One common confusion is the difference between a psychologist and psychiatrist and psychotherapist. The term psychotherapist is very broad and encompasses all the trained clinicians - social workers, marriage and family therapists, licensed counselors, psychologists, and psychiatrists. All psychiatrists are trained in psychotherapy. After training, some psychiatrists choose to focus more on diagnostics or medication management, while others focus on psychotherapy. The style of psychotherapy depends a bit on where they trained. For example, in my residency I learned about psychodynamic psychotherapy, CBT, group approaches, and more.

What is Important in Choosing a Therapy or Therapist?

The most important aspect of a therapy relationship is the rapport between the patient/client and the therapist. Research shows that the relationship with the therapist - sometimes referred to as the therapeutic alliance - is often the biggest predictor of how effective the therapy will be - more so than the style of therapy. Choosing a therapist, like choosing a spouse for example, is also a process. Just like you wouldn't necessarily marry the very first person you go on a date with, it may take time to find the right therapy fit. 

I like to match the therapy style more to the symptoms with which an individual presents and their goals rather than the diagnosis. I would not say for anxiety, use this type. Instead, it matters what kind of anxiety. If your anxiety has a lot of catastrophic thoughts you may benefit from a style of therapy that is different than if your anxiety feels more physical in your body. 

Psychotherapy Styles

The following is a description of several types of psychotherapies, but it is not an exhaustive list.

These are ones I tend to use with patients, ones that I refer my patients to, and those that have been studied in the literature. However, just because there is research does not mean it is necessarily better - it could mean that a particular style of therapy is easier to study. For example, some therapies are time limited 12-16 weeks are are therefore easier to study. 

Cognitive Behavioral Therapy

This is one of the most studied and trained styles of psychotherapy. It is effective! It is based on what is called the Cognitive Triangle - the idea that there is a relationship between our thoughts, our feelings, and our behaviors. One of the founding fathers of CBT, Dr. Aaron Beck, passed away in 2021 (you can read more about him and CBT here: https://beckinstitute.org/about/dr-aaron-beck/). CBT lends itself well to both working with a therapist as well as doing work on your own in a workbook. For example, for anxiety, I often refer my patients to the Anxiety and Worry Workbook written by Dr. Beck. 

The goal of CBT is to help you notice thought patterns that are not working for you - to recognize cognitive distortions and thought errors. A common one is catastrophic thoughts. For example, the thought train might go from "I made a mistake at work" to "I'm going to get fired" to "I will be destitute." CBT can help you step off that catastrophic thought train. Another common type of thought error is Black and White Thinking or All or Nothing. For example, if you are working on a healthy eating plan and you choose to have the pizza at a work event or a cupcake at a party and decide that you are failing completely. That kind of all or nothing thinking makes it hard to get back to your goals. If you have already decided you failed, then it is really easy to feel frustrated or hopeless and throw your hands up for all the meals for the rest of the week, rather than treating it as one meal out of the 21 that you have in a given 7 day week. 

CBT is often a structured type of therapy and the therapist will likely give you homework to complete. A common homework exercise is to notice automatic thoughts and create evidence for or against the thought. 

Mindfulness based therapy

The definition of mindfulness is the awareness that comes from paying attention to the present, on purpose and without judgment. There are religious and spiritual foundations to mindfulness, such as those found in buddhism and hinduism. Then, in 1979, Dr. Jon Kabat-Zinn founded Mindfulness-Based Stress Reduction. His research focused on using mindfulness in clinical settings and stress situations, such as breast cancer. 

There is a lot of data on the benefits of mindfulness based therapies - mindfulness based stress reduction and mindfulness based cognitive therapy. Here are several that focused on women's mental health and perinatal mental health:

  • In 2018, a meta-analysis in the Archives of Women's Mental Health looked at mind-body interventions and mindfulness in fertility patients found it was helpful for anxiety/depression. 

  • A randomized controlled trial in BMC Pregnancy in 2019 enrolled women in the second trimester of pregnancy and found a benefit to an 8-week series of mindfulness. 

  • A meta-analysis by Billie Talyor et. al. in 2016 reviewed many studies and aggregated them. They noted, "Participants reported benefitting from connecting with others in a group setting, learning to stay in the present moment, learning to regulate negative responses to challenging situations, and becoming more accepting of current experiences." The research showed an improvement in depression, anxiety, and stress before and after the interventions. 

And there are many others. Many therapists incorporate mindfulness techniques into their therapy sessions. 

Interpersonal Psychotherapy (IPT)

Interpersonal Psychotherapy emphasizes how relationships and interpersonal connections impact our mental health. Often, the focus is on role or identity transitions (such as becoming a new mother for example) or losses/grief or other major life transitions (like a new job or a move). Similar to CBT, it can be time-limited and structured, but in contrast to CBT, where the focus is on thoughts and beliefs, here the focus is on relationship dynamics. 

Acceptance & Commitment Therapy (ACT)

This therapy focuses on the acceptance of negative emotions. This can be challenging, especially if this wasn't something you were taught in your home growing up. I have worked with many patients who described how growing up, emotions, particularly negative emotions, weren't acknowledged. This leads to the development of a pattern of pushing away and resisting these emotions. But they do not go away. Generally, they show up in less adaptive ways in other parts of our lives. This therapy will teach you to sit with and accept that as a human you have emotional experiences, including negative emotions, and doing so in a non-judgmental way. 

Other elements of ACT include learning to be present and defining yourself and your values. And then, committing to certain actions and behaviors that will bring you closer to those values and your goals. 

Psychoanalysis and psychodynamic psychotherapy

When you hear about classic psychotherapy and Freud, we are usually talking about psychoanalysis, which is often multiple times per week. Psychodynamic therapy is an outgrowth of that, about 1-2x/week, but follows many of the same principles. The focus is on gaining insight about yourself, your emotions, how your mind works and your relationship with your world and how your past experiences influence your present. 

Trauma Focused Therapies

There are several psychotherapies developed specifically to help those navigating trauma. Here are a few:

  • Somatic experiencing therapy - This focuses more on the body and how we experience emotions and sensations in our body. There is an emphasis on mindfulness and grounding techniques.

  • EMDR: Eye Movement Desensitization and Reprocessing - This takes traumatic memories and uses a combination of eye movements and rhythmic right-left movements like taps to reduce the vividness of those memories. It has good data for PTSD. it can also be an intense experience and I usually recommend a foundation of emotional stability before undertaking it. 

  • Cognitive Processing: This is a specific type of CBT for PTSD.

Exposure and Response Prevention (ERP)

This type of therapy is often geared towards treating phobias and OCD. It exposes you to stressful situations in a safe environment. A classic example is fear of germs: The treatment might have you gradually increase your exposure to a germ, for example by touching a door knob, and sit with the emotions that come up rather than doing a compulsive behavior like washing your hands.

One example I've seen quite a bit in my clinic is a new mom with obsessive thoughts about the health of her baby. The corresponding compulsive behavior might be seeking reassurance from the pediatrician or others or doing extensive deep dives into Google searches. The goal here would be to prevent that reassurance seeking behavior and learn to sit with that distress and use coping skills to manage it and see it improve over time. That resolution phase is so important. 


Narrative therapy

The key crux of narrative therapy is that you are the expert on yourself and can rewrite your life story. 

Dialectal Behavior Therapy (DBT)

This therapy style, an offshoot of CBT, was originally developed by Marsha Linehan, PhD, as a way of treating Borderline personality disorder. More and more, it is applied beyond that condition and many find it helpful for teaching ways to navigate difficult emotions. The themes include improving emotional regulation, learning  distress tolerance skills, accessing mindfulness tools, and becoming more interpersonally effective. It is a very practical type of therapy and can be done in either an individual or group setting. Because it is so helpful, I have referred many patients to DBT groups in my area. 

Mentalization

This therapy style has been studied as an effective treatment for Borderline Personality Disorder and is based on psychodynamic principles. Mentalizing is how we define our thoughts and emotions (our mental state) and recognize that it is different from someone else's mental state. This therapy helps you grow this recognition skill. 

This is not nearly an exhaustive list of therapy styles. Also, many clinicians, myself included, integrate multiple approaches. The most important advice I can offer is to find a therapist with whom you have a good connection, then ask questions about their approach. Be sure to set goals early on and plan with your therapist how you'll work towards those goals, and periodically reassess. It may take a few tries to find the best therapist for you, but it is worth investing that time and energy and effort. 

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