Fieldwork Counselling

Types of Therapy—Which One is Right for Me?

I often think there is something strange about searching for a therapist. Website’s like Psychology Today list “types of therapy” under treatment approach as if we, the prospective clients, know what the heck they are talking about. CBT, EFT, DBT, IFS, AEDP, EMDR—wait—what?

Yeah. It’s a lot of acronyms. Should we, as clients, know what we are getting into? Should we chose a therapist based on the type of therapy they practice or should we go with the therapist our friend recommended or whose office is just down the street from us?

For those of us who have the privilege of choice, it can be overwhelming. It is especially overwhelming when we don’t know what the heck the acronyms mean. I may not be able to help you make the right choice for you—only you can do that—but I can certainly help in unpacking the acronyms in this beginner’s guide to exploring just some of the types of therapy out there.\

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy (CBT) has been referred to as the “gold standard” of therapy and this is largely because it is the most researched type of therapy. Cognitive behaviour therapy is based on the following assumption:

“A reorganization of one’s self-statements will result in a corresponding reorganization of one’s behaviour” (Corey, 2011)

CBT is often a short-form of therapy that teaches clients strategies and skills for improving their ability to handle problems of daily living. The focus is not on behaviour or emotions but on one’s thoughts. The idea is that it is our thoughts, attitudes, and beliefs that impact how we feel or behave. CBT often calls on clients to become aware of their thoughts, identify distortions in thinking, and separate themselves from their thoughts—for example, the knowledge that, “I am not my thoughts.”

Who is CBT for (and not for)?

CBT might be a fit for you if you are looking to gain skills for managing daily living and you aren’t opposed to doing some “homework.” Like most things, CBT skills are learned through practice.

If you are keen to explore your past, including how past experiences or traumas are impacting your present-day life, CBT might not be for you. Though modern approaches to CBT value and emphasize the importance of the client-therapist relationship, it is not as relationship-oriented as other approaches, another consideration if the relationship between your therapist is of the utmost important to you.

Emotionally Focused Therapy (EFT)

Simply put, if CBT is thinky, EFT is all about the feels. This is a popular and proven approach to couples counselling (check out Sue Johnson’s Hold Me Tight for some at-home learning), but is also used with individuals and families. According to the International Centre for Excellence in Emotionally Focused Therapy:

“The EFT model prioritizes emotion and emotional regulation as the key organizing agents in individual experience and key relationship interactions.”

According to EFT, emotions have the power to “move” us and evoke change. Emotion is seen as a huge driver of how we relate to ourselves and the world and in EFT, our emotions are seen as the essential transforming agent in therapy that works.

Who is EFT for (and not for)?

EFT has a strong evidence-base for couples work and if you are someone who feels disconnected from your feelings or who has a desire to dive into your emotional experience, this might be the route for you. You usually won’t get “homework” assigned in the same way as CBT.

For couples seeking EFT therapy, contradictions (meaning, EFT is not recommended) if there is a lack of safety in the relationship (i.e. violence), unaddressed addictions, or ongoing boundary violations (i.e. an affair that is not consensually non-monogamous). EFT is also not recommended for individuals with panic disorder or impulse disorder.

Dialectical Behavioural Therapy (DBT)

Thought DBT is a well-known and respected approach to treating difficult-to-treat conditions such as Borderline Personality Disorder (BPD) in professional communities, it has been made mainstream famous by celebrities such as Selena Gomez and Lady Gaga. Dialectical means “the existence of opposites,” which reflects the central strategies taught in DBT of both acceptance and change.

DBT was develoepd by Masha M. Linehan, who talks about her own struggle with BPD and the journey that led her to develop DBT in her memoir Building a Life Worth Living. According to Linehan:

“It is hard to be happy without a life worth living. This is a fundamental tenet of DBT. Of course, all lives are worth living in reality. No life is not worth living. But what is important is that you experience your life as worth living—one that is satisfying, and one that brings happiness.”

DBT can be access through DBT skills training groups or individual therapy. The groups focus on teaching people effective and practical skills for daily living, including mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. DBT is similar to CBT, but it is more focused on the emotional and social aspects of living.

Who is DBT for (and not for)?

DBT was developed for people with borderline personality disorder (BPD), and it is also helpful for suicidal behaviour, self-harm, substance use, PTSD, depresison, and eating disorders.

DBT tends to require a long-term commitment so it is not appropriate for individuals seeking a quick-fix. Like CBT, clients are often encouraged to practice the skills that they learn in therapy in their lives outside of the therapy room.

Internal Family Systems (IFS)

This model assumes that each of us has a number of sub-personalities or “parts” that make up our inner world. These parts function as a system and in this model, the goal is to have the Self (our seat of consciousness and the part of us that is calm, confidence, wise, compassionate, etc.) take the wheel.

According to Richard C. Schwartz, founder of IFS:

“A part is not just a temporary emotional state or habitual thought pattern. Instead, it is a discrete and autonomous mental system that has an idiosyncratic range of emotion, style of expression, set of abilities, desires, and view of the world. In other words, it is as if we each contain a society of people, each of whom is at a different age and has different interests, talents, and temperaments.”

The goals of IFS are to achieve harmony in the system and to have the Self differentiate and take the lead. Although some of our parts might make life difficult, at times, the idea is that each of these parts is serving to protect us in the only way it knows how.

Who is IFS for (and not for)?

IFS can be applied with individuals, couples, or families. It’s been shown to be effective in treating phobia, panic, generalized anxiety, and depression. There are some issues thought to impact the effectiveness of therapy, including abuse or lack of support from the external system (the people in our lives). Those experiencing schizophrenia or dementia may experience less success with IFS.

This one might seem a bit more “out there” than other approaches, but if you are open to giving it a try, there is a book called by Schwartz called No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model that might be worth checking out.

Accelerated Experiential Dynamic Psychotherapy (AEDP)

AEDP is all about the “undoing of aloneness” through in-depth processing of challenging emotional and relational experiences. A major focus of the therapy is on the relationship between client and therapist, with one of the main pillars of AEDP being “the power of being seen and understood.” In the word’s of AEDP’s founder Diana Fosha:

“It is hard to imagine how therapy could yield successful outcomes if there were no sense of warmth, attachment, and care between clinician and client.”

AEDP believes that clients have the innate capacity to heal. It believes that emotional experiences have the capacity to transform us. Within the safe and trusting relationship of client and therapist, client’s process avoided emotions and move towards psychological well-being. This therapy very much takes place in the present moment and emphasis is on the therapeutic relationship as it is being experienced in that moment.

Who is AEDP for (and not for)

You may have noticed the emphasis on the therapeutic relationship in this approach. For many folks, this can be positive and it is also one of the most widely studied factor that contributes to therapeutic change. However, some of the therapeutic techniques of AEDP can be challenging for people who have strong defence mechanisms or high levels of hostility. For those experiences depersonalization or derealization it may also be counterproductive.

AEDP can be used for individuals and couples and can be effective for a wide variety of populations, including those who are living with the effects of trauma or PTSD.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is an individual therapy that focuses on memory. The idea is that some memories (often traumatic memories) can get “stuck” and have a profound influence on our everyday lives. In the words of Francine Shapiro in Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy:

“Changing the memories that form the way we see ourselves also changes the way we view others. Therefore, our relationships, job performance, what we are willing to do or are able to resist, all move in a positive direction.”

I’m not going to go in-depth into the process or science of EMDR, but once memories are identified, the therapist uses a technique that uses eye movements and other forms of rhythmic left-right stimulations (tones, taps) while the client focuses on a specific memory. Though it may sound strange and is certainly different than a lot of the other approaches mentioned above, it is an evidence-based treatment approach.

Who is EMDR for (and not for)?

Most of the research of EMDR has been on the treatment of PTSD. Though the support is strongest for single-trauma (capital T Trauma), many therapists also use it with complex, trauma or “little t” trauma. For individuals with dissociative disorders, EMDR is cautioned against. There are also physiological conditions that need to be considered such as pregnancy, seizures, or other neurological disorders.

So there you have it, just some of the many acronyms that are going around in the world of therapy. I don’t think, as clients, it is our responsibility to understand these theories. I do, however, think that for some folks, it can feel safer to know what the heck the person sitting across from us is doing. It might also help us to align ourselves with an approach or practice that resonates with us.