If you’re new to therapy, aren't getting the results you want, or are simply wondering what other types of therapy exist, this article will walk through a few common modalities and, more importantly, discuss the effectiveness of therapy and the modalities you pursue.
For this article, we interviewed Dr. Tom Malia, Licensed Clinical Psychologist and owner of Growth Psychological Services in Illinois, to bring you the best insights into the world of therapy straight from a licensed practitioner:
What are the most common therapy modalities?
Cognitive-Behavioral Therapy
According to Dr. Malia, cognitive-behavioral therapy (CBT) is “the most widely known and practiced approach.” Most therapists use CBT at least to some extent. It’s often the practice most associated with therapy in terms of challenging your thoughts and behaviors.
Dr. Malia explained that CBT focuses on thought patterns and how they influence behaviors and emotions. Here’s how this may show up during therapy:
- What is the evidence I have for this being true?
- What is the evidence I have for it being false?
- How does that evidence change the way I want to think about this topic?
- How does a stimulus or situation trigger specific thoughts?
- When that thought is triggered, what emotion does it elicit?
- When I think and feel that way, how do I act?
The focus in CBT is often breaking down these connections and understanding them so that you know how to make changes in thoughts, behaviors, or in the environment around you to improve your life.
Psychodynamic and psychoanalytic approaches
According to Dr. Malia, “psychodynamic and psychoanalytic approaches tend to focus on exploring the origins of why you think, feel, and interact with people the way you do.” He noted that CBT tends to be more present-focused, while “psychodynamic approaches often look into the past more.”
This can show up in therapy as:
- Trying to get your needs met now that were not met in the past
- Looking for the best way to develop a sense of self
- Understanding your patterns, as well as re-thinking or re-experiencing them in a different way in therapy sessions
- Healing by better understanding how your past experiences are influencing your present
To further explain what “re-experiencing means,” Dr. Malia noted that this process happens directly with your therapist as he or she responds differently to your expectations. For example, you might anticipate your therapist to respond in a negative way based on your past experiences, but when they respond empathically, you are “re-experiencing” the situation in a healthier way with your therapist.
Humanistic therapy
Humanistic approaches are more philosophical in nature. There's often more of a bend toward embracing inherent good in the client, a focus on "common factors" like empathy and genuineness from the therapist.
Most importantly, there’s a very strong individualized approach to treatment. Every person has different goals, values, strengths, and present experiences. The therapist doesn't define what's healthy, and is there to support the client in exploring and finding what is healthy for them and what would make a more full and meaningful life.
Financial therapy
Financial therapy is a specialized branch of humanistic philosophy that combines therapeutic support with financial expertise to help you follow through on your financial plans and goals. Financial stress can be destabilizing. By improving your finances, you can more easily improve other areas of your life too.
Do therapists truly fall into one modality or another?
Dr. Malia explained that most therapists will say they’re integrative or holistic, meaning they’re not rigid about staying in one modality or another. Oftentimes, therapists will draw on their training in multiple modalities during a therapy session depending on how they can best help a patient.
Therapists who follow a strict modality are typically part of a research team or working in a highly specialized clinic, so this isn’t something you’ll likely run into as you search for a therapist.
Does it matter which modality you choose?
“The short answer is that the specific therapy modality doesn't actually matter that much,” according to Dr. Malia. “There's a long history of research on therapy outcomes that has pretty consistently found that there is little difference in outcome between different specific therapy approaches. This includes major works by Saul Rosenzweig in 1936, Lester Luborsky in 1975, and Bruce Wampold in 2001.”
To be clear, there is a definite positive outcome to therapy in general compared to no treatment or a placebo. There are many studies such as this one that confirm this.
“But when you compare outcomes for different therapies, the differences pretty much disappear.”
What are your best next steps if you’re seeking therapy?
1. Find someone who specializes in the topics you want support in
According to Dr. Malia, “people looking for a therapist shouldn't worry about the specific modality they say they do. Instead, look for someone who specializes in the kinds of things you want to work on.”
For example, if you have trauma that needs to be processed or worked through, find a trauma specialist. Specific trauma recovery therapies include EMDR, Prolonged Exposure, Brainspotting, and Trauma-Focused CBT. However, you do not necessarily need to see a therapist who uses these techniques in order to make progress in your treatment.
2. Search for a therapist you can trust and feel connected to
Overall, the strength of the bond between the therapist and client, or as we call it the therapeutic alliance, accounts for about 7% of the effectiveness of therapy. The therapeutic modality only accounts for around 1%. The rest is due to the personalities of the therapist and client and "common factors" that are found in every therapeutic approach:
- Empathy
- Genuineness
- Creation of expectations and goals
The best thing to look for is whether you feel like the therapist is someone you can connect with. Dr. Malia explained that while “this can sound a bit intangible and can be hard to pin down what that might mean for you, it is so central to what needs to happen for therapy to be successful that it can't be overlooked.”
Where to find a therapist
We recommend either asking your primary care provider for a referral or searching the following databases by location and topic:
- Psychology Today - largest online networks of trusted therapists
- Zocdoc - in-network therapists
- Good Therapy - directory and resource hub for therapists
- Therapy Den - inclusivity-focused database
- Open Path Collective - low cost therapy for those with a limited budget or inadequate/no insurance
- Financial Therapy Association - vetted financial therapists
- Therapists for Highly Sensitive People (HSPs) - therapists who work specifically with highly sensitive people
All of these sites are respected and used by top therapists and doctors across the country. You can read reviews of various therapists and find out what they specialize in.
Another option is to get referrals from people you trust, like friends, family or members of your community (family, community group, church, club, etc.).
Keep in mind that many traditional therapy offices also offer telehealth appointments if going to a therapist’s office doesn’t fit your schedule or needs.
Not sure if you need a therapist? Read this next: How to Know if You Need a Therapist
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