Which type of therapy is most effective?

It depends on the condition. CBT has the broadest evidence base across conditions. ERP is the clear winner for OCD. EMDR and PE lead for PTSD. DBT is gold standard for borderline personality disorder. For many conditions, different modalities produce similar outcomes — the therapeutic alliance and your engagement matter as much as the specific technique.

Can I do more than one type of therapy?

Yes. Some people do individual CBT and group DBT simultaneously. Others start with EMDR for trauma processing, then switch to psychodynamic therapy for ongoing pattern exploration. Sequential approaches (addressing acute symptoms first, then deeper patterns) are common and often ideal.

Is online therapy as effective as in-person?

For CBT, the evidence strongly supports equivalent outcomes via telehealth. Other modalities have less telehealth-specific research but are generally considered effective online. Exceptions may include severe dissociative conditions and situations requiring in-person safety assessment.

How do I know if my therapy is working?

Expect some improvement within 6-8 sessions for structured therapies (CBT, EMDR). Signs of progress: reduced symptom frequency/intensity, better functioning, more self-awareness, improved relationships. If nothing has changed after 8-10 sessions, discuss this with your therapist — the approach, the fit, or both may need adjustment.

Types of Therapy Compared: CBT, DBT, EMDR, Psychodynamic, and More

Not all therapy is the same, and the differences matter for outcomes. Choosing between therapy types without understanding them is like choosing a medical specialist by throwing a dart. Each modality has a theory of change, specific techniques, and conditions where it performs best. The right match between your needs and the therapy approach is one of the most important factors in successful treatment — alongside the quality of the therapeutic relationship.

Cognitive Behavioral Therapy (CBT)

How it works: CBT targets the relationship between thoughts, feelings, and behaviors. You learn to identify distorted thinking patterns (catastrophizing, black-and-white thinking, mind-reading) and replace them with more balanced alternatives. Behavioral components include exposure to feared situations and behavioral activation (scheduling activities that counter withdrawal).

Best for: Anxiety disorders, depression, insomnia (CBT-I), panic disorder, phobias, and eating disorders. CBT has the largest evidence base of any psychotherapy.

What to expect: Structured sessions (12-20 typical), homework between sessions, skills-based focus. Present-oriented rather than past-focused. Your therapist is active and directive.

Limitations: May feel overly structured for people who want to explore deeper patterns. Less evidence for personality disorders, complex trauma, and relational issues.

Dialectical Behavior Therapy (DBT)

How it works: Developed by Marsha Linehan for borderline personality disorder, DBT combines cognitive-behavioral techniques with mindfulness and acceptance strategies. It teaches four skill sets: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The "dialectical" part balances acceptance (you're okay as you are) with change (and you need to change).

Best for: Borderline personality disorder, chronic suicidality, self-harm, emotional dysregulation, and substance use disorders with emotional instability. Increasingly used for complex PTSD and eating disorders.

What to expect: Typically includes weekly individual therapy, weekly group skills training, phone coaching between sessions, and therapist consultation teams. The full model is comprehensive and intensive.

Limitations: Time-intensive (standard DBT is 6-12 months). Not widely available in full-model format in all areas. May be more than needed for milder conditions.

EMDR (Eye Movement Desensitization and Reprocessing)

How it works: Uses bilateral stimulation (eye movements, tapping, or auditory tones) while you focus on traumatic memories to help the brain reprocess them. Based on the Adaptive Information Processing model — the idea that trauma gets "stuck" in the brain without proper integration.

Best for: PTSD, single-event trauma, phobias, and anxiety rooted in specific experiences.

What to expect: 6-12 sessions for single-event trauma. Less homework than CBT. You don't need to narrate trauma in detail. Sessions can be emotionally intense during processing.

Limitations: Less evidence for conditions not rooted in specific events. Quality varies significantly by practitioner training level. Not a fit for everyone.

Psychodynamic Therapy

How it works: Explores how unconscious patterns, early relationships, and past experiences shape current behavior. The therapeutic relationship itself becomes a tool — patterns you replay in life tend to show up in how you relate to your therapist, providing real-time material for exploration.

Best for: Recurring relationship patterns, identity issues, personality disorders, chronic depression not responsive to CBT, self-understanding. People who ask "why do I keep doing this?" rather than "how do I stop this specific symptom."

What to expect: Less structured than CBT. Open-ended exploration. Often longer-term (months to years). The therapist is less directive — following your lead rather than assigning homework.

Limitations: Slower to produce symptom relief than structured therapies. Evidence base is growing but smaller than CBT's. Quality depends heavily on therapist skill.

Acceptance and Commitment Therapy (ACT)

How it works: Instead of changing thoughts (like CBT), ACT teaches you to change your relationship with thoughts. Core processes: acceptance (allowing difficult thoughts/feelings without fighting them), defusion (unhooking from thoughts), values clarification (identifying what matters), and committed action (living according to values despite discomfort).

Best for: Chronic pain, anxiety, depression (especially when CBT feels too argumentative), substance use, and conditions where fighting the problem maintains it. ACT is particularly suited for people who've tried to think their way out of problems unsuccessfully.

What to expect: Experiential exercises, metaphors, mindfulness components. Less homework-heavy than CBT. Focus on building a meaningful life rather than eliminating symptoms.

Other Modalities Worth Knowing

Interpersonal Therapy (IPT): Addresses depression through improving relationships and role transitions. Strong evidence, especially for postpartum depression.

Somatic Experiencing: Body-based approach for trauma. Works with physical sensations rather than narratives. Particularly useful for people who dissociate during talk therapy.

Emotionally Focused Therapy (EFT): The gold standard for couples therapy. Addresses attachment patterns and emotional bonds.

Internal Family Systems (IFS): Views the psyche as containing multiple "parts" with different roles. Growing evidence for trauma, depression, and self-criticism.

How to Choose

Match the modality to your primary concern. OCD → ERP (a specific CBT variant). PTSD → PE, CPT, or EMDR. Depression → CBT, BA, or IPT. Emotional dysregulation → DBT. Recurring patterns → psychodynamic. Chronic conditions → ACT. Couples → EFT. If unsure, CBT is a reasonable starting point for most anxiety and depression presentations. And regardless of modality, the therapeutic relationship matters — find someone you trust and can be honest with.