What to Expect From Different Types of Therapy: A Brief Overview
Written by Kally Doyle
Welcome! You have probably heard through a friend or family member about the many benefits of therapy, and are now contemplating whether you may be ready to start this journey for yourself. There seems to be a lot to consider at first! If you’ve began your search for a therapist already, you have likely read about all the different ways they can offer you help- but it may still seem unclear as to what therapy actually entails. I’d like to walk you through a few different factors I believe are instrumental in determining the answer to this important question. I will focus largely on CBT versus Psychodynamic therapy, as these are two very popular and often contrasted approaches.
Anticipated Duration of Treatment
Before we go any further, I would suggest asking yourself “How long do I expect to be in therapy?” It’s totally ok if you don’t have an answer. In fact, I would suggest refraining from trying to put a cap on the amount of time you will allow yourself to participate in therapy, at least initially.
The reason I still suggest asking yourself this question is because you likely won’t be as satisfied with therapy if you were going to dedicate 3 months, for example, to the process, and you ended up choosing a therapist who does not use a brief or “manualized” approach to therapy. If you are limited in the amount of total time, money, or number of sessions you can receive at this time, it may be a more suitable option to choose a therapist who utilizes Cognitive-Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance-and-Commitment Therapy or Solution-Focused Brief Therapy. I won’t dive into the specifics of each of these theories, but the basic reason for naming them here is because they utilize specific interventions and guidelines that are often more suitable for short-term therapy than those approaches that are focused more on increasing your personal insight or providing a strong emphasis on client-counselor rapport (psychodynamic, humanistic, attachment-based therapy, etc.).
Some examples of reasons why you may have a restriction on the length of your therapy could include: EAP programs offer a certain number of sessions (sometimes it can be as few as 4 sessions), financial restrictions, time constrictions, or personal preference. If working to gain a deeper understanding of why you have a certain issue is less important to you than improving the symptom itself, brief therapies such as those mentioned above may prove more beneficial to you. An example of when one might choose CBT over, say, Psychodynamic therapy, would be if that individual is trying to reduce the frequency of their insomnia episodes. Someone who is not sleeping very well may be less enthusiastic about spending time telling their traumas, or analyzing their defenses, and will understandably prefer a therapy with direct interventions that they can try in and out of sessions to improve their sleep. CBT and other similar behavioral therapies are often heavily advertised as “evidence-based practices”, which gains them popularity by insurance companies who are more willing to approve therapy with data that shows symptom improvement in a specific amount of sessions. Psychodynamic therapy does have research supporting its efficacy as well, and there can be briefer versions of it available, but by far the current trend is for agencies to push CBT and the like, especially in facilities who rely on insurance reimbursements for their funding. Despite being promoted as “the” evidence-based therapy approach, there appears to be misrepresentation of the strength of the evidence provided in research thus far (see studies discussed later). Critics of CBT often cite research that reports it only provides temporary relief from symptoms, and that it is misleading to clients who seek it out because of high-level of praise the words “evidence-based” seem to bestow upon it. Despite this criticism, it remains a very popular approach today and I would argue that it does have its place.
So, you may be wondering…if brief therapy exists, then why would I want to engage in therapy that may take many months to many years to achieve my goals? Wouldn’t it be better to just “get it over with”, and save money and time? Well, not always.
Type of Issue I am Dealing With & Resolution I am Hoping For
Depending on the issue(s) you are looking to address, you may actually benefit more from longer-term therapy. Why? Rome wasn’t built in a day- and neither were your problems.
Let’s take Lucy for example- Lucy is searching for a therapist to help her address her depression, anxiety, and relationship issues. Lucy and her partner have been arguing every week, and all Lucy knows to do is leave for several hours to help herself calm down. Lucy is tired of this pattern, and she is able to recognize afterwards that it hurts her partner’s feelings when she just up and leaves, but doesn’t understand how to change this about herself.
A manual-based approach such as CBT may be able to help Lucy identify thinking errors, name her triggers, learn assertive communication skills, and learn relaxation techniques. All of these could definitely be of use to Lucy.
A relational (meaning the therapeutic relationship as well as the client’s past/present relationships are explored and valued) and insight-based approach such as Psychodynamic therapy may be able to help Lucy in slowing down, and really examining why she reacts this way to her partner, and which past experiences are contributing to this tendency. Often, the contributing factors to one’s behavior are not made immediately aware for that person. This is why psychodynamic therapy and related models often take longer to help improve an individual’s symptoms; one or two CBT sessions may be able to suffice in identifying and subsequently coping better with Lucy’s triggers, whereas identifying what is going on beneath the surface for Lucy in those moments- going deeper than just naming triggers- can take anywhere from 6 months to multiple years. In this case with Lucy, over time, and with the help of her therapist’s interpretations, she may come to realize she is unconsciously projecting her experience with her emotionally unavailable father onto her partner and once she begins to learn why this is occurring, she begins to be able to stay through arguments and thus less arguments occur in the long run.
Which approach sounds better- or, in other words, which approach sounds more effective for Lucy? I think it depends on the therapist you ask; this is because therapists usually choose their theoretical approach based on how they view their own issues, and their own values and beliefs. It also depends on Lucy’s preference. Not everyone finds theoretical approaches like CBT suitable to their needs, especially if they are looking to dive deeper into understanding themselves. Alternatively, not everyone sees the value in analyzing their words, interactions, relationships, and behaviors to uncover their unconscious defenses.
Research to Consider
If you ask me personally, it is my belief that brief therapies often only manage to reduce symptoms for a period of time, versus symptom reduction that lasts longer in duration and is present more consistently throughout one’s life. An article monitoring depression symptoms in people who underwent CBT therapy plus clinical management (medications) cites that these individuals originally reported improvements in their depression symptoms after these two combined treatments, but when their depression symptoms were assessed anywhere from 16 months to 6 years later, the majority of participants reported relapse in their depression symptoms (Perlis, 2005). In an article by Knekt et al. (2008), short-term psychodynamic therapy was compared to long-term psychodynamic therapy, as well as both types being compared to Solution Focused Brief Therapy in the treatment of mood and anxiety disorders. The study followed up on the effectiveness of the 3 different types of therapy over the next 3 years after administration and found that the answer depended on when follow-up assessments were given to participants. More specifically, the study found no significant differences between SFBT and Brief Psychodynamic therapy, but did find that at the 1 year mark, the Short-term Psychodynamic therapy was reported most effective in reducing mood and anxiety disorder symptoms, but then at the 3 year mark, the long-term Psychodynamic therapy was reported to be most effective in reducing mood and anxiety disorder symptoms. The authors thus concluded that for faster symptom relief, brief therapies are the better option but for longer-term relief, longer-term therapy is preferred (Knekt et al., 2008). These results make sense for you as the client to consider because if you only have 8 therapy sessions provided by your employer’s EAP program, it is best to choose a therapist offering a form of brief therapy. If you are unsure if a potential therapist does offer this- just ask! You deserve to get the most out of your therapy.
If you do not have a session limit placed on you by insurance, EAP, or other factors, the above research and my personal opinion would encourage you to consider a longer-term therapy route in order to see longer-lasting changes. Personally, I’d rather invest in therapy for 1 year versus 3 months if I knew that the research points to the likelihood of more permanent benefits from an extended therapy process.
Another way of using these research findings in your decision to choose a specific therapy style could be asking yourself the question: “What is my motivation for therapy at this time?”. If your answer is something like “I need to sleep at night” or “I want to be able to take my upcoming final exam without having a panic attack” (something more immediate and direct), Cognitive-Behavioral Therapy, Solution-Focused Brief Therapy, or a therapy of the like is probably a better match for you right now. If your answer is something more along the lines of “I’d like to understand why I have such bad anxiety” then longer-term, Psychodynamic therapy would be my recommendation. I’d also like to add different therapy styles may be more appropriate at different times in your life. For example, even if CBT may not bring you permanent change, it may help get you over a specific hurdle for the time being and potentially later in life you could return to address the underlying issue in Psychodynamic therapy or the like.
That being said, my opinion is just one opinion of the many that exist- and research substantiates claims of the efficacy of many different types of therapy, meaning one approach (CBT versus Psychodynamic versus Humanistic versus Solution-focused, etc.) really isn’t generally superior to others. Furthermore, what makes a certain therapy approach effective is also up for debate: therapist gender, age, experience, adherence to the therapy modality they choose to use, type of mental health issue being treated, client age, client experience in personal relationships, etc. all seem to play a role. Confusing right? We do, however, know that the bottom line is that the relationship between therapist and client seems to have the highest impact on client satisfaction in therapy. One study included 5 different types of therapists (one therapist group used CBT, one group used Psychodynamic, one group used Humanistic, one used an “eclectic” or blended approach, and the other category of therapist approach was “not specified/other/unsure”) to assess which therapy approach led to clients feeling the most positive regard (support, warmth, empathy, encouragement) from the therapist (Suzuki, Mandavia, & Farber, 2019). Results indicated that overall, Psychodynamic therapy was ranked the highest in level of positive regard by participants; however, when positive regard was broken down into subcategories, it was reported that CBT therapists provided more positive regard in more specific dimensions measured through other assessments (Suzuki et al., 2019). This study highlights the true complexity behind understanding what exact components make therapy successful, and offers the conclusion that ultimately the effectiveness of a therapy style likely depends more on true authenticity on the part of the therapist in showing the client care, warmth, and support versus exactly how they do so (Suzuki et al., 2019).
Final Remarks
One therapist also cannot treat every illness or issue that exists. Despite being passionate about psychodynamic therapy, I recognize there are times other approaches like CBT will likely be more beneficial to a client. In this case, I will refer the client to a therapist who uses an approach more suitable to the client’s requests, preferences, and issue.
Many therapists also do consider themselves “eclectic” in terms of theory used. This means they pull from several different theories based on what will best serve the client. Even if a therapist has a certification in a specific type of therapy, they still often will pull from other types from time to time. An exception to this may be in the case of practitioners who use Dialectical Behavioral Therapy (DBT) as my understanding is that the model requires high fidelity (meaning certified DBT therapists are expected to practice with solely DBT techniques and interventions). DBT requires this because it wants to adhere to”evidence-based practices”, and if various practitioners are dabbling around when they feel like it, DBT cannot ethically maintain its title as research and evidenced-based.
There are many more styles of therapy used by clinicians versus those that have been mentioned and discussed in this article. I recognize that only focusing on a few here is a definite limitation to my points; however I chose CBT and Psychodynamic to focus on due to their popularity at this time. There are also somatic therapies, attachment-based therapies, other behavioral therapies, other interpretation and insight-based therapies, etc. out there and arguably all hold value in this field.
Overall, the anticipated take-aways from this article for you as the reader would be: make an informed decision on the type and length of therapy that is most appropriate for you. Make sure you communicate to your potential therapist how long you are planning to stay in therapy (especially if your sessions have to be limited in number). And most importantly, find a therapist that you click with in order to get the most out of your therapy experience.
References
Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., Laaksonen, M. A., Marttunen, M., Kaipainen, M., Renlund, C., & Helsinki Psychotherapy Study Group. (2008). Randomized trial on the effectiveness of long- and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38(5), 689–703. https://doi.org/10.1017/S003329170700164X
Perlis, R. H., MD. (2005, August 01). Cognitive behavioural therapy has short term but not long term benefits in people with residual symptoms of depression. Retrieved from https://ebmh.bmj.com/content/8/3/75
Suzuki, J. Y., Mandavia, A., & Farber, B. A. (2019). Clients’ perceptions of positive regard across four therapeutic orientations. Journal of Psychotherapy Integration. doi:10.1037/int0000186
