Finding the right mental health support can be confusing and a real barrier to seeking help. It's often difficult to know where to start, and the abundance of choice can feel overwhelming. You may have heard of CBT, DBT or EFT, perhaps seen them on various websites. So what do all these acronyms mean and which may be best suited for you? There are some overlap and common factors among the different therapeutic modalities, however each have their distinct theories and particular emphasis. Here are some of the most common evidence-based therapies you'll likely come across.
Psychodynamic: Originating from Sigmund Freud's psychoanalytic traditions, psychodynamic therapies stress the role of the unconscious. Psychological symptoms are viewed as defenses against unacceptable impulses, and often indirect expressions of unconscious desires. The goal of therapy is to use free association and other techniques to uncover and resolve conflicts between the conscious and unconscious mind. One's thoughts, feelings, and behaviours are believed to be determined by one's early experiences in childhood and stored in the unconscious mind. A major component of therapy is exploration of the past and connecting the dots between one's early life experiences with current difficulties. Psychoanalysis and psychodynamic therapies tend to be more open-ended and longer term. This form of therapy may appeal to those seeking insight into recurring patterns in their lives and how they came to be who they are.
Behavioural: Behavioural therapies emerged as a rejection of Freud and psychoanalysis. Behavioural therapy largely ignores the unconscious and emotions. Therapy focuses on the present and content from one's past is only considered if relevant to the current presenting issues. Problematic behaviours are believed to be acquired and the goal of therapy is to recondition the individual. Sessions are highly structured, symptom focused and action based. Therapeutic progress is measured by the amount of behavioural change and relies heavily on independent practices in between sessions. Behavioural therapy is appropriate for those who have concrete goals of changing a specific behaviour, such as overcoming specific fears or OCD.
Cognitive Behavioural Therapy (CBT): Currently one of the most well known and prevalent forms of therapies, CBT is manualized and has been widely adapted for group therapy and self-help resources. CBT examines the relationship between our thoughts, feelings and behaviours. The goal of CBT is to manage unhelpful emotions and behaviours by changing one's thinking. CBT utilizes a number of techniques and exercises to help individuals identify and challenge inaccurate and unhelpful thoughts contributing to their distress. Like behavioural therapy, progress is strongly reliant on practices and "homework" outside of therapy. Therefore, CBT would likely appeal to those who prefer structure and independent work in-between sessions. CBT can also be brief, with the average course of treatment between 12-20 sessions.
Dialectical Behavioural Therapy (DBT): Originally created for treatment of Borderline Personality Disorder, DBT is an intensive treatment that integrates elements of cognitive behavioural therapy with mindfulness. As the name suggests, the guiding principle of DBT is holding a balance of 2 opposing forces of acceptance AND change. DBT emphasizes skills teaching to change, and cope with, unhealthy behaviours. Comprehensive DBT therapy consists of group-based skills training, individual therapy, and phone coaching for crisis between sessions. Therapists in private practice often offer DBT-informed therapy that does not include the group and phone coaching components. DBT is particularly helpful for individuals with extreme difficulty with emotion regulation, self-harm behaviours and chronic thoughts of suicide.
Emotion Focused Therapy (EFT): EFT comes from humanistic and process oriented traditions. EFT aims to alleviate distress by directly changing underlying maladaptive emotional processes. This is done by increasing awareness, expression, understanding, integration, and transformation of emotions. Like other humanistic therapies, the therapeutic relationship is embedded in conditions of presence, empathy, and acceptance. The majority of therapeutic work takes place in sessions. Progress and change occurs when the individual is able to access and experience healthier emotions with the support of the therapist. EFT has been successfully adapted for couples and is currently one of the main evidence-based forms of couples therapy. Individuals or couples experiencing repetitive "stuck" emotions or wanting to work through emotional pain will likely benefit from this approach.
Acceptance and Commitment Therapy (ACT): Unlike other forms of therapy that orient towards change, ACT takes a major pivot and advocates accepting what is outside of one's control and committing to effective actions in creating a rich and meaningful life. ACT views psychopathology as the result of attempts to get rid of perceived "symptoms" and unwanted experiences. ACT makes use of metaphors, mindfulness skills, and a range of experiential exercises to help individuals develop psychological flexibility as an alternative to avoiding or wrestling with distressing thoughts and feelings. Those who are struggling with existential issues or feeling lost in life may find this form of therapy particularly grounding. ACT will also appeal to those interested in a different way of coping with painful thoughts and feelings by learning how to reduce their impact.
Oftentimes, you'll see a therapist describe themselves as Integrative. Integrative therapists acknowledge the strength as well as the limitation of each therapeutic modality. Therapy therefore aims to incorporate theories and techniques from different approaches to flexibly meet the unique needs of each individual client.
These are understandably brief and shallow descriptions of rich bodies of work. If you find a particular description resonates with you, I encourage you to do your own research or ask your GP for further information. Getting a sense of what the different types of therapy is about can direct you in your search for the therapist that is right for you.
You can also read about what to expect from a first therapy session in this blog post.