Which Type of Therapy Is Right for You?

Does therapy work?

Therapy can help, and it does not work for everyone. One review of 441 trials found that about 42% of people treated for major depression had at least a 50% drop in symptoms by the end of therapy. Rates for several anxiety disorders and PTSD were in the 30s. Those are averages from research studies, so your own result may be different. Missing that 50% mark does not mean a person got no benefit. Finding the best treatment may take trial and error, and one poor response does not close the door on others.

What "evidence based" means

The American Psychological Association defines evidence-based practice as combining the best available research with clinical expertise, in the context of the patient's characteristics, culture and preferences. A therapy with few trials may be unproven, which is different from being ineffective. When you see a claim about any therapy, ask whether it was tested against a comparison group, how many people took part, and whether anyone other than its promoters has studied it.

How strong is the research on each approach?

It varies a lot.

• ERP. The National Institute of Mental Health says it effectively reduces compulsive behaviors, and a published review describes it as the first-line psychotherapy for OCD. Anxiety may rise at first, and not everyone gets full relief. See what ERP involves.
• CBT. It is a well-studied option for many conditions, including anxiety and depression. It appears often partly because researchers have tested it so widely.
• ACT. It has a sizable research base, and experts read it differently. A 2020 review by ACT researchers reported that it was efficacious for every condition examined. A more skeptical 2014 meta-analysis called it "not yet well-established for any disorder." See what ACT is.
• Psychodynamic therapy. It has a real evidence base, especially for depression, though it has been studied less rigorously than CBT in some conditions. See a plain-language guide.
• EMDR and trauma-focused CBT. A 2020 analysis of 90 trials concluded that they appear most effective at reducing symptoms and improving remission in adults with PTSD. The evidence was moderate to low in quality.
• IFS. The evidence so far is a small set of early studies, and no large trial has shown that it beats an established therapy. That does not mean it cannot help you. See what IFS is.
• Somatic therapy. It is promising but not yet well proven. A 2021 review of its best-known method, Somatic Experiencing, wrote that "the current evidence base is weak." See what somatic therapy is.

A therapy's name does not tell you everything

Many therapists blend methods, and two therapists who use the word "somatic" may do quite different things. A named therapy only counts if the therapist actually does it. If your OCD treatment never involves facing a fear, you may not be getting ERP. So ask what a clinician actually does in sessions.

Weekly therapy is not a crisis service. If you are having thoughts of suicide or self-harm right now, call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.

Start with what you are treating

A few conditions have a clearly favored therapy. For others, several therapies perform about equally. Much of this research is in adults.

Concern	Best supported	Keep in mind
OCD	ERP, a specific type of CBT	General talk therapy is a different treatment, so ask for ERP by name
PTSD in adults	Trauma-focused therapies: cognitive processing therapy (CPT), prolonged exposure (PE), other trauma-focused CBT, and EMDR	Guidelines differ on EMDR. The VA/DoD guideline gives CPT, EMDR and PE a strong recommendation, and the UK's NICE guideline recommends EMDR for non-combat trauma. The American Psychological Association puts CPT, PE and trauma-focused CBT in its top tier and EMDR in a second tier, and found insufficient evidence that one is better when they are compared directly
Depression	CBT and interpersonal therapy; short-term psychodynamic therapy performed similarly to other therapies	The National Institute of Mental Health says therapy is often tried first for milder depression, while moderate or severe depression usually includes medication in the initial plan
Generalized anxiety	CBT; a growing body of research for ACT	ACT has less research behind it than CBT
Chronic insomnia	CBT for insomnia, recommended as the initial treatment for adults	Moderate-quality evidence behind a strong recommendation

A therapy being listed does not mean it is the only option or that it will work for you. See the full condition-by-condition table. Mania, psychosis, an eating disorder with medical risk, or thoughts of suicide can all mean that a medical evaluation or a higher level of care comes before any choice of therapy style. If you are having thoughts of suicide or self-harm right now, call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.

When the research does not pick a winner

• CBT or ACT. In studies of anxiety and depression, the two usually produce similar results overall. CBT teaches you to examine a thought. ACT teaches you to notice it and act on your values whether or not it goes away.
• CBT or psychodynamic. For depression and anxiety, research on structured, often time-limited versions suggests that outcomes are broadly similar. Critics read one key analysis as a small disadvantage for psychodynamic therapy, a reading its authors reject.
• EMDR, CPT or prolonged exposure. No test can tell you in advance which will work best for you. In most cases EMDR does not ask you to talk through the details, though you do think about the trauma in session. It does not require homework, while CPT and PE do. Prolonged exposure involves detailed talking from around session 3.
• Individual or group. For many common problems, they work about equally well in research. PTSD is an exception, where individual trauma-focused treatment is the better-supported starting point.

CBT or DBT, and what individual DBT means

As a broad rule, CBT tends to fit a specific symptom pattern, and DBT tends to fit when emotions escalate fast and feel dangerous or out of control. Standard DBT usually includes a weekly skills group. Mind Body Seven has no DBT group or full DBT team, so individual DBT here is not the same treatment as the model tested in major trials. Evidence for one-on-one skills teaching is thinner.

Ask about a full program if you have had recent suicide attempts, repeated self-harm, or frequent emergency room visits or hospital stays. If you are having thoughts of suicide or self-harm right now, call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.

Your preference counts

Across 53 studies, people who received the kind of therapy they preferred dropped out less and did somewhat better.

What to say when you reach out

Name your main concern in plain words. "I cannot stop checking the stove" leads somewhere different from "I have felt flat for a year." Mention every concern at the start, including substance use and sleep, since they can change the order of treatment. To begin, request a consultation, and the intake team confirms fit, scheduling and costs.

Questions to ask a therapist

The National Institute of Mental Health suggests asking several of these. A good therapist should be able to answer them.

• What is the rationale for this therapy, and what is its evidence base?
• What training have you had in this specific method?
• Do you recommend a specific time frame or number of sessions?
• How will progress be assessed?
• What happens if I am not improving?

How often, and for how long?

Most people start therapy once a week. Many focused therapies last around three months, while long-standing or complex problems can take a year or more. There is no universal number. Agree on a plan with your therapist and a date to review it. For example, you might step back after 8 to 12 sessions and ask what is working. That is a common-sense checkpoint, and it is not a clinical rule. This guide to frequency and length gives typical ranges.

If it does not feel right

Say it plainly and early, in a sentence or two: "Something about our sessions is not working for me, and I would like to talk about it." A good therapist should treat this as useful information. Here is how to give honest feedback. If you are not getting better after what feels like a reasonable time, NIMH advises talking to your therapist and considering other professionals or approaches. You are allowed to change therapists.

When you may be done

You and your therapist decide together when you are ready, usually by checking your progress against your goals. Raise it while you still have sessions left, and read how to know you are ready. Ending therapy is not a one-way door, and you can contact your therapist again. Ending therapy and stopping medication are separate decisions. Keep your prescriber in the loop, and do not stop or change a medication on your own.

Cost

Frequency affects cost, so talk about money early. Mind Body Seven is an out-of-network practice, and it does not accept Medicare or Medicaid, including managed Medicaid. For many clients with Cigna, Aetna or BCBS plans it files out-of-network claims, and superbills are available in the patient portal for other carriers such as UnitedHealthcare. A Good Faith Estimate is available on request. See fees and insurance.

If your safety is in question, do not wait for your next session. If you are having thoughts of suicide or self-harm, call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.