Types of Psychological Therapies

A brief summary of mainstream psychological therapies of the modern era.

Therapy styles discussed in this post include the insight therapiesPsychodynamic and Humanistic; and the cognitive-behavioural therapiesCBT, Third-Wave therapies, and a couple of others.

When deciding on a psychological therapy you might like to know roughly what’s in store for you. Although they all involve talking to some degree, what you’ll talk about and what exercises you’ll be asked to engage in will differ. I would say they all have one major thing in common, and that is we don’t know exactly how they work, although each has a theory behind it, and some are more scientific than others.

As to which is better, there is a school of thought that they all do roughly the same thing and it doesn’t matter much, and it does seem that a good working relationship between the therapist and client is still the most important factor behind successful therapy. However, there is evidence out there suggesting some therapies are better for treating certain disorders, so receiving a good assessment by a competent clinician will help in your choice.

Often though, you’ll go to see a clinician after a recommendation or a search on the internet, and they will already have training in certain therapies, so it would be useful at that stage to know what they are offering. Here’s a quick run-down of the major therapy styles available in the Western world at least, in roughly chronological order of their development.

Insight Therapies

Insight therapies aim to help a client by improving their awareness and understanding of relevant aspects of their psychological functioning. With this increased insight the client is able to make positive changes to their life. I’m not formally trained in these therapies, but I know enough to pass on the basics.

Psychodynamic Psychotherapy, including Psychoanalysis (345 words)

The Austrian neurologist Sigmund Freud was a pioneer in developing a formal ‘talking cure’ for mental health problems, beginning in the late nineteenth century with psychoanalysis, and his body of work has been very influential on Western culture more generally. Psychodynamic theories and therapies were once dominant, but began to wane in influence from roughly the 1970’s. They nevertheless remain a significant alternative to the cognitive-behavioural therapies I’ll discuss later.

Psychodynamic psychotherapy presumes the existence of subconscious psychological processes, (including basic drives and motivations), that are thought to significantly influence our behaviour and psychological wellbeing. By identifying damaging processes and bringing these to light, the therapist hopes to release the client from their influence.  These processes develop gradually throughout our lives, particularly in our impressionable childhood years, and are influenced heavily by interactions with our family. Consequently, there is a focus on the past, and on interpersonal relationships.

The therapist will look for subtle, often symbolic cues as to the source of distress and dysfunction, and may interpret dreams, which are a meaningful product of the unconscious mind (according to the theory).The relationship between the therapist and client is particularly important, as it represents a source of data, so-called ‘transference’, when the interpersonal patterns of the past are played out between the client and the therapist in the present.

Hence psychodynamic psychotherapists will generally take on a less active role, letting the client do most of the talking. And they are quite disciplined in their approach to therapy so that they don’t muddy the waters; for example they’ll typically maintain regular appointments at the same place and time, and will disclose relatively little about themselves in session.

The less active role of the therapist, and the rather ambitious goal of uncovering the unconscious mind means this therapy can be slow going, and that requires a substantial investment of time, and probably money. But you can expect to learn more about yourself in the process. It doesn’t have a strong scientific basis, although studies have shown it to be effective for a range of problems.

Humanistic Therapy (215 words)

Carl Rogers, who developed a humanistic ‘client-centred’ approach to therapy from the 1940’s to the 1980’s, is still thought of as one of the most influential of all clinicians. The humanistic approach was never taught to me formally in my clinical training, but his client-centred principles are infused in the way therapy is taught, and hence in the way most therapists work.

The client is presumed to have within them the ability to change for the better, and achieve personal growth. The therapist is led by the client, helping them to gain insight along the way. As in Psychodynamic Therapy, the client tends to do most of the talking; and the direction therapy takes depends on what issues or ideas the client brings to the table (…or chair, more commonly). The therapist uses active listening to reflect back the client’s own ideas in a way that promotes insight, treats the client with ‘unconditional positive regard’ to bolster their own self-regard, and shows empathy and understanding towards the client. Lovely stuff :-).

Humanistic psychology doesn’t really offer specific theories of mental disorders, and so a purely humanistic approach to therapy may not suffice for those in an acute stage of mental illness. It aims rather to promote personal growth, and to help people achieve their potential.

Cognitive & Behavioural Therapies

The psychological therapies in this category focus more on changing what you do, rather than building insight, (although increased knowledge and awareness is important still). Their development began in the 1950’s and has continued until the present day. They can be split into roughly three groups – Behaviour Therapy, Cognitive Therapy, (together, ‘Cognitive Behaviour Therapy’), and finally, the so-called ‘Third-Wave’ therapies.

Cognitive Behaviour Therapy (CBT; 530 words)

The main assumptions of CBT are that our thoughts, feelings and actions are interconnected, and hence changing one will lead to changes in the others, offering opportunities for targeted therapeutic interventions. The relationship between them is often portrayed by diagram below.


Whereas in psychodynamic theories the majority of important psychological processes are unavailable to our conscious awareness, CBT assumes that whilst much of our thinking may be automatic and out of awareness, with a little practice we can begin to notice our thoughts, and connect them with related feelings and actions. This allows us to consciously make beneficial changes to these processes. The therapist’s job is to help the client to develop the skills to identify and change the relevant processes, leading to improved psychological health, and providing additional coping skills for the future; when successful, the client becomes their own therapist.

Behavioural techniques were the first to be developed, and came with a fairly rigorous scientific backing (at least by psychological standards). Research has shown that certain habits of behaviour maintain psychological problems. For example, for those suffering from excess anxiety, consistently avoiding what they fear maintains this anxiety in the long run, as they never have the opportunity to disconfirm their expectations of threat. To address this, behavioural techniques for anxiety involve facing our fears (called exposure therapy). There are also behavioural techniques for depression, which aim to reverse corrosive patterns of withdrawal and social isolation. Behavioural techniques are widely used to manage behavioural problems in children, and adults in some cases, by manipulating the pattern of positive and negative consequences following targeted behaviours.

Cognitive techniques came later, and are premised on the idea that the way we feel is a direct result of our thoughts, specifically the way we appraise a situation. And although our perspective on the world is certainly influenced by our upbringing and events of the past, the focus of CBT is on the present, in that we can change how we presently think in order to improve our psychological condition. CT generally involves monitoring thoughts to identify patterns of thinking that are maintaining poor psychological health, and will then employ techniques to test the validity of these usually biased and unrealistically negative thoughts, thereby weakening their hold on our emotional health.

CBT is probably the most well researched psychological therapy, and there is a fair bit of evidence supporting its effectiveness.  It is also quite targeted and can be effective in a relatively short time, (weeks or months, sometimes even just one session for simpler problems like specific phobias eg, spiders). It requires more effort from the client though, who is generally set homework tasks, and we need to repeatedly use skills to get them to a point where they are effective. Treatments like exposure therapy are potentially very effective, but only if you can talk someone into doing them: facing our fears is not, at first, a pleasant experience (although it can be very empowering once accomplished). And the cognitive techniques use our conscious thinking to challenge ingrained ways of seeing the world, which can be quite a big ask for some people, especially those who are not psychologically minded.

Third Wave Therapies (515 words)

These therapy styles came to prominence in the 1990s (give or take), and are generally influenced by Eastern philosophies. Whereas the CT in CBT asks us to change the content of our thoughts, which leads to a change in how we feel and act, these therapies ask us to change the way we relate to our inner psychological world. Many promote acceptance of our thoughts and feelings by learning to view them as merely psychological and physical events that we can choose not to engage with, if it is unhelpful to do so. We learn not so much to change our psychology, as to live with it.


Mindfulness Based Stress Reduction (MBSR) was one of the earlier therapies to adapt certain meditation techniques into a psychological therapy. This particular therapy is generally conducted in a group format, and is almost entirely based on applications of Mindfulness. Mindfulness practice is quite experiential, as you can’t really understand what it is without doing it. MBSR uses mostly meditation exercises.

All of the other third-wave therapies I mention below include some concept of Mindfulness.

Dialectical Behaviour Therapy (DBT)

This therapy was developed in response to the specific needs of a particular clinical group, but is now used more widely. It combines pretty pragmatic behavioural techniques with Mindfulness and other skills-based practices. DBT therapists are often more forthcoming in style, may disclose more about themselves, and will sometimes be available to consult with their clients out of session (often to coach people through crises).  Some therapists use DBT techniques to supplement their main therapy modality, but this won’t be the full DBT experience.

Acceptance and Commitment Therapy (ACT)

As the name suggests, ACT promotes acceptance of our psychological experience, and asks the client to commit to living life according to what they most value. In ACT, the therapist will help the client to see that the way they have struggled to manage their symptoms so far has not helped, and may even be making things worse. They then make use of a range of analogies and other techniques, such as Mindfulness, to help the client accept their negative thoughts and feelings, and re-focus on living a meaningful life, taking some of their symptoms along for the ride! Although symptom reduction is not the aim of ACT, the paradox of acceptance is that by not trying to reduce symptoms we no longer fuel them, and they may subside as a result.

Metacognitive Therapy (MCT)

This therapy focusses not on managing symptoms directly, but on managing what we think about our symptoms, and how we respond to those symptoms. It has elements in common with ACT, although acceptance itself is not a central theme. Many of the techniques are designed to change the processes of thinking without necessarily changing the content of thinking. It nevertheless aims to challenge unhelpful thoughts about our own symptoms, such as worrying about how we worry too much, which only adds to the worry (and don’t I know it!). It also uses analogies, visualisation techniques, attention training, and a more specific concept of Mindfulness (without the meditation practice).

A Couple of Others (130 words)

Schema Therapy

Still quite new, Schema Therapy combines the focus on thinking from Cognitive Therapy, with the past focus and longer term approach of Psychodynamic Therapy. The CT part of CBT focusses (at least initially) on individual thoughts identified by the client, but recognises that these thoughts come from ‘core beliefs’ that we hold about the world. Schemas are collections of core beliefs on related topics, and so represent maps or blueprints of our life. Schema Therapy aims to improve our psychological health by re-programming these schemas, re-drawing the maps in our mind in a sense. It can be quite experiential, dealing with significant memories and themes from a client’s life.

Interpersonal Psychotherapy (IPT)

This cognitive-behavioural therapy is an evidence-based treatment for depression, and focusses on the interpersonal aspects of this disorder.

Finance Analogies: Mental Accounting and the Positive Events Diary

I make a case for paying extra attention to the positive events in our lives, and offer one way of doing this: 460 words.

As a former accounting and finance professional I like to find some common ground between my two careers. Here’s my fourth attempt…

In life we can expect some events to add value, and some to reduce value. For example, when we receive a compliment this adds value, and when someone insults us this diminishes value, if we take it seriously anyway. As an accountant, I would record transactions that increased and decreased the value of an organisation, namely income (credits), and expenses (debits). Of course, many expenses are necessary, as we can’t expect to achieve anything without incurring cost. But on the whole we hope to make a net profit (more income than expenses).

Sometimes, though, our mental version of accounting goes a bit haywire. We start recording only the negatives, and fail to notice the positives. This is very common in depression, when we become biased towards noticing failure and setbacks. The reality for the depressed person may well be okay, but their disorder stops them from seeing this.

In accounting we record financial transactions in a ledger. If we are keeping a kind of depressive ledger, recording just the expenses in our life, then we will soon start to question whether it’s worth doing anything at all; we become hopeless. To counter this, we can start to keep a second set of books, in which we will record only mental ‘income’.

Clinicians call this a positive events diary. At the end of the day we can take a simple note of the good things that have happened during that day, whether little or big, and by doing this we begin to build a more accurate picture of our lives. It’s an unashamedly biased exercise, because depression is biased too. Think of it as affirmative action for your positive thoughts.

Each time you do something that your depression would have prevented you from doing, record this as a positive event. It’s an achievement for many depressed people just to get out of bed in the morning. All the usual good things can go in there, and don’t take things for granted. If you make someone laugh, enjoy your morning coffee, or get a question right at college, or in a work meeting, all these are positives and deserve to be recorded. Social media can be used in this way. If we take Facebook as an example, spend less time examining others’ highly curated lives, and record your own ‘best of’; you don’t even need to share these publicly, but going to the trouble of recording these events will remind you of them, and you can look back over them in the low times.

However you do it, keeping a positive events’ diary is a relatively simple way of balancing your mental books. And although you don’t need to be an accountant to do it, you might find consulting with a therapist will help you keep track of all those mental credits.

How to Use Mindfulness

How to use Mindfulness for improved psychological wellbeing: 850 words.

The psychological practice of Mindfulness (derived from Eastern meditation practices) is de rigueur at the moment, being promoted as a standalone practice for psychological wellbeing, and forming part of a number of evidence based psychological therapies. A straightforward definition of Mindfulness is to pay attention to the present moment, and to do so non-judgementally. And although anything can be done in a Mindful fashion, there are a number of formal Mindfulness exercises designed to promote this skill, such as paying attention to our natural breathing.

When running therapy groups I noticed that my clients thought of Mindfulness mainly as a relaxation exercise, but Mindfulness can help in more ways than this. What follows is a summary of ways that we can use Mindfulness to promote mental wellbeing. I will start with the simplest uses, and progress to trickier, but potentially very rewarding applications.


An exercise like Mindful Breathing can focus our mind on the rise and fall of our breathing, these natural rhythms serving to calm an agitated mind. And some people will combine Mindful attention with relaxation exercises, such as controlled breathing and progressive muscle relaxation, which are designed to calm us physiologically as well as psychologically.


Our attention is a limited mental resource, and when our mind is focussed on a certain aspect of the present moment, it is not thinking about other, possibly less pleasant things. Hence Mindfulness as a form of distraction can help to dampen distressing emotions, and reduce worry and ruminative thinking.


Much of our mental and physical activity occurs automatically and outside of awareness. Anybody who has regularly driven along the same route has probably experienced getting to their destination without noticing a single part of the journey, perhaps lost deep in thought the whole way. But the car wasn’t driving itself, (although that technology is on its way!), so many parts of your brain must have been working diligently in the background. In a similar way, many of the negative mental processes implicated in mental health disorders occur automatically and outside of awareness.

Exercises like Mindful Breathing, Eating, and Walking, train us to become aware of activities that are frequently automatic, and to examine them with curiosity, rather than jumping to an instinctive judgement.  We can then apply this same skill to other automatic events, particularly the unhelpful thinking patterns, corrosive emotions, and reactive behaviours that contribute towards mental health problems. As a former management accountant we used to adhere to the maxim ‘what isn’t measured can’t be managed’, and in psychology we could say that ‘what isn’t noticed can’t be changed’. So the greater insight we can achieve with Mindfulness allows us to begin that change process. Be aware though that noticing unpleasant thoughts and emotions for the first time can be confronting, so it’s helpful to have a therapist or other trusted person available for support.

Confronting Unpleasant Emotions

Negative emotions fulfil important functions, and must play a role in our lives. But we tend to avoid what we don’t like, and very few of us like our negative emotions. Taking the edge off an unpleasant feeling is okay, but there is plenty of evidence that excessive avoidance of unpleasant emotions is ineffective in the long run, leading to greater negative emotion overall. Hence we are better off learning how to confront and understand our negative emotions, so that we might respond to them in a more considered way. Being Mindful of both the mental and physical components of our emotions, paying attention to them with curiosity rather than judgement, can teach us that these are just sensations like any others. With dedicated practice we can learn to weather the storm, ‘sitting’ with our emotions long enough to decide how best to respond to them.


A great paradox of Mindfulness is that by learning to simply observe internal and external events, (including our thoughts and emotions), instead of trying to control them, we are in fact better able to control how we respond to them, and hence influence how they impact upon us. This is because many of our reactions to events are automatic, born from habit or reflex, and our attempts to control particularly internal events, like emotions, are ineffective in the long run. The restraint of a seasoned Mindfulness practitioner allows them to respond to events in a more controlled manner, consistent with their best interests in the longer term.

A Way to Live

If we integrate Minfulness into our lives then we begin to live in the moment. And the reality is that the present moment is all we have. Sure, there are memories of the past, and we will have new experiences in the future, but even these things can only be thought about in the present moment.

An old supervisor of mine used to call thinking about the past or future ‘time travel’. It is important to learn from the past and plan for the future, but if we spend too much time travelling then we miss out on the present anyway, so what was the point of all that thinking?

To Beat Depression you have to be a Strongman

A metaphor illustrating an evidenced based treatment for depression called Behavioural Activation: 460 words.

Working with depressed clients has reminded me of the world’s strongest man competitions I used to watch as a child. In one event, competitors would pull heavy vehicles strapped to their waste, and living with depression can feel like we are constantly dragging a heavy weight behind us. Strength alone was not enough to shift these enormous objects – their approach mattered. The Strongmen would lean forward to take the strain, and with their first small steps they would barely move off the mark, despite great strength and determination. In fact, they might sometimes slip backwards, trying too hard without sufficient traction. But with a steady persistence they would inevitably gain forward motion. From here they would build momentum, and gradually lengthen their stride. Before long they were moving at a normal walking pace. It was an impressive feat considering the weight they were pulling. In a similar way to this, it is possible for people to progress in life despite the weight of their depressive illness.

Depression reduces motivation, draining people of energy and instilling a sense of hopelessness and pointlessness. Understandably, people often reduce their activity levels and isolate themselves socially. Unfortunately, these responses strengthen depression by eliminating the few remaining opportunities to be rewarded by life, thereby confirming negative expectations and further reducing motivation in a vicious cycle.

An evidenced based approach to treating depression, Behavioural Activation, targets these maintaining factors. Like the strength athletes in the vehicle-pull event, we can expect a slow and potentially discouraging start. It requires very small steps, and a deliberate and focused approach. Schedule activities that instil a sense of achievement, increase connection to others, or are things you’ve enjoyed in the past. At first these might involve getting out of bed before midday, making a simple meal for a significant other, or going for a coffee at your local café, and regular exercise is recommended. Trying too hard can set us up for a slip backwards, and will probably confirm thoughts of failure. As we begin to build momentum mood can lift, and it will be possible to lengthen our stride by taking on more challenges. Maintaining momentum is important, so keep scheduling a variety of rewarding activities, and commit to doing these despite low motivation. Giving in to a few bad days here and there will not bring us to a grinding halt, but returning to patterns of withdrawal and isolation will, so get back on track when you can. When depression finally lifts it is easy to become complacent, so treatment guidelines recommend a focus on relapse prevention.

We needn’t cower in the shadow of depression. If it’s managed well we can live a meaningful life, and maintaining engagement in life is part of managing a depressive illness.