A beginner's guide to therapy modalities (Part 1)

What they are and how they differ

For a long time, I thought therapy was just… therapy. A thing you did in an office (maybe over zoom), with one person (the expert) talking with you (the client). You spoke, they asked questions, and somewhere along the way, you were supposed to feel better.

Over time, I learned that the world of therapy is actually quite vast, and the Good Will Hunting version of therapy is just one piece of the puzzle. While certain approaches dominate, it turns out there are many ways to do therapy and many modalities.

Despite this diversity, “the system” (i.e., healthcare, insurance, grad school, etc.) tends to favor certain ones, and as a consumer, it can be hard to learn about your options or determine what might be the best fit for you. It’s a big step to decide to go to therapy. Then on top of that, you have to figure out what kind, if the therapist is any good, insurance logistics, etc. I don’t have data on this, but my guess is that most people end up in whatever therapy modality their first therapist happened to practice, often without even really understanding what type they practice. Personally, I spent years in traditional talk therapy before learning that many different approaches and modalities existed (see my first post).

Therapy nostalgia for Millennials.

It’s a lot to sort through, and it should be easier to navigate. Things are slowly changing with social media and the overall destigmatization of mental health, but we have a ways to go. I believe understanding your options and what’s available empowers you to a) make more informed decisions about your care and b) ask better questions when you’re looking for support.

In that spirit, I wanted to do a quick review of some of the leading therapy modalities. This list is by no means exhaustive but at the very least, it lets you know there are different options out there and gives some high-level direction for those that want to dig deeper.

The Foundations

Psychology as a field is relatively new. It wasn't until the late 1800s that it became its own scientific discipline, separate from philosophy. Wilhelm Wundt established the first experimental psychology laboratory in Leipzig in 1879, officially kickstarting the field. In 1890, William James published The Principles of Psychology, a foundational American text on the subject. Meanwhile in Austria, Sigmund Freud developed psychoanalysis and published The Interpretation of Dreams in 1899. Like most academic fields of the era, (Western) psychology was largely developed by white men with women routinely denied degrees and academic positions despite making significant contributions. Sigh. The three approaches below are considered foundational to the field and have greatly influenced later approaches as well.

Psychoanalysis / Freudian Psychoanalysis
Psychoanalysis, rooted in Freudian psychology, is a theory and therapeutic approach developed by Sigmund Freud, one of the pioneers of modern psychotherapy. Freud believed that unconscious thoughts, feelings, and desires drive human behavior. Several of Freud’s core ideas – that much of our mental life is unconscious, that early childhood experiences shape adult behavior, and that bringing unconscious material into awareness can produce healing – remain influential a century later, even where they have been revised or challenged. Classical psychoanalysis (i.e. a person on a couch, analyst behind them, multiple sessions a week for years) is less common these days, but psychoanalytic thinking runs through much of modern therapy. See: Psychology Today: Psychoanalysis.

Jungian Analysis / Jungian Therapy
Carl Jung, another key figure in psychotherapy, developed his theory of the mind after his public split from Freud. Jungian analysis goes beyond the personal unconscious to also explore what Jung called the collective unconscious, i.e. the idea that there is shared symbolic and archetypal material that underlies all human experience across cultures. Key Jungian concepts include dream analysis, archetypes, the shadow, individuation, and the Self. Jung’s influence on the consciousness and healing world has been enormous, and many of his ideas about shadow work, inner figures, and the multiplicity of the psyche have become mainstream and greatly influenced newer therapy modalities. See: Psychology Today: Jungian Therapy.

Psychodynamic Therapy
Psychodynamic therapy is based on the principles of psychoanalysis but treatment is typically weekly and involves shorter sessions than traditional psychoanalysis. Think of it as the modern, updated cousin. In a Psychodynamic session, you have open-ended conversations with your therapist and explore how your thoughts, feelings, unconscious processes, early experiences, and relationship patterns influence your behavior and emotional life today. A lot of psychodynamic therapy also integrates attachment theory, which describes how our earliest bonds with caregivers shape our patterns of connection and relationship throughout life (e.g. see the book: Attached). Much of what we think of as talk therapy today is psychodynamic therapy. See Psychology Today: Psychodynamic Therapy.

According to the internet, Dr. Melfi practiced psychodynamic therapy.

Cognitive & Behavioral Approaches

By the mid 20th century, psychoanalysis began to lose steam, and new schools of thought emerged in response. Behaviorism rose to prominence, led by B.F. Skinner and others who argued that psychology should focus on ‘observable behavior’ rather than the murky, elusive unconscious. Humanistic and experiential approaches like Gestalt therapy and Carl Rogers’ person-centered therapy also became influential and emphasized awareness, authenticity, and an individual’s innate capacity for growth. In the 1960s, psychiatrist Aaron Beck developed cognitive therapy, which focused on identifying and modifying distorted patterns of thinking. This approach later merged with behavioral principles to form Cognitive Behavioral Therapy or CBT. CBT was seen as faster, more structured, and more empirically measurable than psychoanalysis, and it was quickly adopted by healthcare systems and insurers. It also led to the development of several other modalities that are rooted in a cognitive behavioral approach.

Cognitive Behavioral Therapy (CBT)
Aaron Beck developed CBT after noticing that his depressed patients had a stream of negative automatic thoughts that they rarely questioned. He found that helping patients identify and challenge those thoughts produced meaningful symptom relief, often faster than psychoanalysis. Today, CBT is one of the most widely practiced and extensively researched forms of therapy. It’s based on the idea that our thoughts, feelings, and behaviors are interconnected and that by identifying and changing unhelpful thought patterns, we can change how we feel and act. It’s very structured, skills-based, and goal-oriented. It’s also often recommended as a first-line treatment for depression, anxiety, and a range of other conditions in most clinical guidelines. See Psychology Today: Cognitive Behavioral Therapy.

Acceptance and Commitment Therapy (ACT)
ACT was developed in the 1980s by psychologist Steven C. Hayes, a professor at the University of Nevada. ACT grew out of the CBT tradition while departing from it in important ways. It’s built on the idea that psychological suffering often comes from our attempts to avoid or control painful thoughts and feelings rather than the thoughts and feelings themselves. Rather than trying to eliminate difficult experiences, ACT focuses on accepting them and committing to actions aligned with your values. Today, it’s widely used for anxiety, depression, chronic pain, and stress. See Psychology Today: ACT.

Dialectical Behavior Therapy (DBT)
DBT was originally developed by clinician Marsha Linehan for people with borderline personality disorder and has since expanded to treat depression, PTSD, eating disorders, and substance use. The name “dialectical” refers to the idea that two opposite things can be true at once. In DBT, that means accepting yourself exactly as you are while also committing to change. The framework teaches four core skills: distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness. It is based on CBT but differs in its emphasis on validation, i.e. the idea that a person’s thoughts and feelings make sense given who they are and their experiences. It’s used in both individual therapy and group skills programs. See Psychology Today: DBT.

Exposure and Response Prevention (ERP)
ERP is a form of CBT and is considered the “gold standard” treatment for OCD. It involves gradually exposing a person to the thoughts, images, or situations that trigger their obsessions, while resisting the urge to perform the compulsive behaviors in response. Therapy typically begins with an assessment and treatment can last several months with exercises outside of session. The goal of ERP is to break the cycle of “obsession and compulsion” by showing that your anxiety and emotional distress can decrease on their own without you engaging in the unwanted or compulsive behavior. See Psychology Today: ERP.

Solution-Focused Brief Therapy (SFBT)
I only learned about SFBT recently but discovered that it’s widely practiced around the world. SFBT is a goal-oriented approach to therapy that helps the client focus on solutions rather than problems. Rather than exploring the root causes of difficulties, SFBT helps people identify what is already working in their lives and build on it. It’s particularly popular in non-Western countries and seen as especially useful for people who want concrete tools and strategies rather than deep exploration. See Psychology Today: Solution-Focused Brief Therapy.

In the next post, I’ll go over more recent modalities, including somatic and trauma-informed approaches like IFS, EMDR, and Somatic Experiencing.

Stay tuned…