This is a map of the main kinds of talking therapy. What each one looks like in the room, and the sorts of difficulty it tends to be used for.
There is no league table here, because the research does not support one. Different approaches suit different concerns and different people. What matters more is the fit between the approach, the problem and you.
What Therapy Actually Is
Psychotherapy is planned treatment that uses conversation as its tool. It has a focus, a method, and a way of checking whether it is working.
What advice does
A friend or a relative tells you what they would do in your place.
What therapy does
A therapist helps you see what is happening and works with you on changing it, which is slower and tends to hold better.
Three things separate therapy from a good conversation.
- It is structured. Sessions have a shape. There is usually a plan agreed early on, and a rough sense of what the work will cover.
- It is collaborative. The goals are set with you, in your words. You are not a passenger in it.
- It is accountable. Progress gets reviewed at points you both know about. If something is not helping, that is information, and the plan can change.
Most approaches also ask for something between sessions. Noticing a pattern, trying a small step, keeping a short record. The hour matters, and so does the week around it.
Therapy is not a place where someone tells you the answer. It is a place where the thing you are stuck in becomes visible enough to work on.
The Main Families of Therapy
These approaches overlap more than the names suggest. Grouping them is a way of showing what each one pays most attention to.
Cognitive behavioural therapy, CBT
CBT works on the loop between what you predict, what you feel in the body, and what you do next. It is practical and structured: you look at real situations from your week, test what you expected against what happened, and try small planned experiments.
It is commonly used for anxiety and panic, low mood, obsessive checking, health worry, and sleep difficulty. Graded exposure, where you approach an avoided situation in agreed steps, sits inside this family.
Dialectical behaviour therapy, DBT
DBT teaches skills for emotions that arrive fast and hard. Sessions cover riding out distress without making things worse, steadying emotion, paying attention on purpose, and handling difficult conversations. There is usually skills practice between sessions, and often a simple daily record.
It is often used where feelings swing sharply, where urges to self-harm are part of the picture, and in some eating and substance difficulties. Full programmes combine individual sessions with a skills group.
Schema therapy
Schema therapy works on patterns that formed early and kept running, mapping the themes that repeat across your life and the coping styles built around them. It uses imagery and chair work as well as talking, so a pattern can be felt rather than described.
It is often used for long-standing relationship patterns, low mood that has been present for years, and difficulties that were there in some form well before the current trouble started. It tends to be slower work aimed at the roots.
Emotion-focused therapy, EFT
EFT treats feelings as information to be worked with rather than noise to be switched off. Sessions slow down on what you feel as you feel it, and often use chair work to bring an unfinished conversation into the room.
It is used for depression, for hurt and loss that has stayed unresolved, and for close relationships. The same initials are also used for emotionally focused therapy with couples, which works on the cycle a couple falls into rather than either partner alone.
Family and couples work
Some difficulties sit between people rather than inside one person. This work brings more than one person into the room and looks at the pattern they make together. Who speaks, who goes quiet, what gets stepped around, what happens after a fight.
It is used for couple distress, family conflict, difficulty across generations in the same home, and for helping a family hold together while one member is unwell. Sessions may include everyone, or move between the whole group and smaller pairings.
Group therapy
A therapy group is a small, stable set of people who meet regularly with one or two trained facilitators. It is not a lecture and not a drop-in. Because the membership stays the same, your usual way of relating shows up in the room.
Groups are used for social anxiety, long-running relationship difficulty, addiction recovery, and grief. Part of what helps is the format: hearing that someone else carries something close to your own, and getting honest reactions from people not paid to be kind to you.
Supportive therapy and counselling
Supportive work aims to steady things rather than to rebuild them. It offers regular contact, a place to think out loud, practical problem solving, and help holding a routine while something hard passes through.
It is used during a crisis, during a long physical illness, after a bereavement, and where someone wants steady support without opening older material. Choosing this is a legitimate choice, not a smaller version of real therapy.
Other approaches exist and are in regular use, including psychodynamic therapy, acceptance and commitment therapy, mindfulness-based programmes, interpersonal therapy and trauma-focused work. The families above are the ones people ask about most.
What The Evidence Means
A short, honest version
An approach is called evidence-based when it has been tested in studies, compared against something else, and the results published where other researchers can check them.
An average is not a prediction
Studies report averages across many people, and an average does not tell you what will happen for you.
Less research is not disproof
An approach with less research behind it is not the same thing as an approach shown to be useless. Some have simply been studied less, often because they are harder to run in a trial.
Evidence narrows the shortlist. It does not make the choice for you.
How Clinicians Actually Choose
In practice, four things decide where the work starts.
- The concern itself. Panic, a long-standing relationship pattern and a recent bereavement are three different problems. They point toward different starting places.
- What the evidence supports. For some difficulties there is a well-tested first choice. For others the research is thinner and more open.
- What you prefer. Someone who wants structure and homework and someone who wants space to explore are asking for different things, and both requests are reasonable. An approach you find intolerable is unlikely to help you, whatever the trial data says.
- Review as you go. The first plan is a starting position, not a verdict. Sessions get reviewed, and the approach can be adjusted or changed.
Many practitioners work integratively. Training usually happens in one main model, and techniques from others get added as the work asks for them. A therapist trained mainly in CBT may still use a chair exercise, and a schema therapist still uses behavioural steps.
That is a fact about how the field runs, and it is not particular to any one clinic.
You are allowed to ask which approach is being used with you and why that one. A clinician who cannot answer that in plain language is worth asking again.
Questions Worth Asking At The Start
These are fair questions in a first or second session, and asking them is part of the work rather than a distraction from it.
- What approach are you planning to use with me, and why that one?
- What will a session actually look like?
- Is there anything to do between sessions?
- How will we know whether this is helping?
- When will we sit down and review it?
- What happens if it does not seem to be working?
- How do you handle confidentiality, and what are the limits of it?
If therapy and medication are both in the picture, it is also fair to ask how the two are meant to fit together. Our medication FAQ covers the common questions people bring about that.
Where To Read Next
A few pages that follow on directly from this one.
- How long does therapy take to work?, on what actually determines the length of a course of therapy
- Finding care that understands your culture, on language, family and faith in the room
- How to find a therapist in Mumbai, on qualifications, cost and the practical search
- Psychiatrist or psychologist, on who does what in Indian practice
- Grief and loss, if what brought you here is a bereavement
The condition pages give more detail on particular difficulties: anxiety, depression, ADHD in adults, addictions, sleep, and the rest of the Learn shelf.
The Weave Family Library is free, needs no sign-up, and is written for people rather than for clinicians. Each book is available in five languages and can be downloaded as a PDF.