What most therapies have in common
The National Institute of Mental Health (NIMH) describes psychotherapy as a group of treatments that help people identify and change troubling emotions, thoughts and behaviors. Its stated goals are the same across approaches: relief from symptoms, better day-to-day functioning and a better quality of life.
NIMH also makes two points that surprise many people. First, there is no formal FDA approval process for psychotherapies the way there is for medications; instead, research with large numbers of patients shows which therapies are effective. Second, therapists may use one primary approach or blend elements of several, depending on their training, the condition and the person in front of them. So the name on a therapist's website is a starting point, not the whole story.
NIMH lists elements that show up across many approaches: learning to cope with stress and solve problems, examining how you interact with others, practicing relaxation or mindfulness, tracking emotions and behaviors, supportive counseling to explore troubling issues, and making a safety plan for thoughts of self-harm. Most therapists draw on several of these, whatever they call their approach.
Cognitive behavioral therapy (CBT)
CBT helps you notice automatic ways of thinking that are inaccurate or harmful, such as "I always mess things up," question them, see how they affect feelings and behavior, and change self-defeating patterns. NIMH lists CBT among the evidence-based therapies for depression and calls it the "gold standard" for generalized anxiety disorder, panic disorder and social anxiety disorder. Sessions are usually structured, and practice between sessions is common.
Exposure therapy is a CBT method for anxiety. NIMH describes it as spending brief periods, in a supportive setting, learning to tolerate the distress caused by certain objects, ideas or imagined scenes, until the fear goes down over time.
Acceptance and commitment therapy (ACT)
ACT takes a different angle from classic CBT. Rather than disputing anxious thoughts, NIMH explains, it encourages nonjudgmental acceptance of them while putting energy into meaningful activities, using mindfulness and goal setting. NIMH notes a growing body of research for GAD and social anxiety. Mayo Clinic describes ACT as a form of CBT and notes it is designed for treatment-resistant conditions.
Interpersonal therapy (IPT)
IPT focuses on how relationships and life events affect mood, and how mood affects them in return. NIMH says it aims to improve communication within relationships, build social support and set realistic expectations for handling crises. That keeps the focus on current relationships and recent life events.
Psychodynamic and insight-oriented therapy
This tradition looks at how earlier experiences, relationships and feelings you may not be fully aware of shape your mood and choices today. NIMH notes that psychodynamic therapy, used for a limited time, may help some people with depression. The NHS includes dynamic interpersonal therapy, in which a therapist helps you see how childhood experiences affect your relationships, among its talking therapies for anxiety and depression. What Is Insight-Oriented Therapy? covers the approach and the research on it.
Other approaches you may hear about
- Behavioral activation: Mayo Clinic describes it as gradually reducing avoidance and isolation and increasing activities you once enjoyed or that lift mood.
- Dialectical behavior therapy (DBT): builds acceptance strategies and problem-solving skills; Mayo Clinic notes it is useful for chronic suicidal thoughts or self-injury.
- Mindfulness-based therapy: paying attention to thoughts and feelings without judging them. The NHS offers mindfulness-based cognitive therapy for depression.
- Counseling and supportive therapy: talking through problems with a trained professional who helps you find your own solutions, as the NHS describes it.
- Group therapy: working on depression or anxiety with others and a therapist. NIMH notes group CBT can offer unique benefits for social anxiety.
- Couples or family therapy: Mayo Clinic notes that working out stress in close relationships can help with depression.
Does the type matter?
Sometimes. NIMH notes that treatment is often tailored to the condition: the approach for obsessive-compulsive disorder differs from the approach for bipolar disorder, for example. For anxiety disorders, NIMH describes CBT methods that involve gradually facing what is feared as commonly used. For broader, longer-standing struggles with mood, self-worth and relationships, people often look for therapy that also explores where the patterns started.
The relationship matters too. NIMH stresses that rapport and trust are essential, because therapy is deeply personal. If you have given therapy a reasonable amount of time and are not improving, NIMH suggests raising it with your therapist and considering other professionals or approaches. Mayo Clinic gives the same advice: try a different approach, or someone else.
Questions to ask any therapist
- What approach do you use, and why do you think it fits what I am dealing with?
- What training do you have in it?
- What would the first sessions focus on, and how is progress tracked?
- About how long do people usually work with you on something like this?
- What happens if I am not getting better?
- Can you prescribe, and if not, how do you work with prescribers?
Questions to Ask a Therapist About Anxiety or Depression has a longer list for a first call.
Dr. Lehmann's approach
Dr. Lehmann's approach is insight-oriented and integrative. Therapy with her looks at your history, family dynamics and current functioning, and combines that understanding with practical feedback and coping skills. If you are considering a specific named method, ask her directly how her work compares. You can read more about anxiety therapy and depression therapy with her.