Common Therapy Modalities and How to Know What Feels Right for You
With increasing acceptance of mental health support, conversations about therapy have become more common. You might have a friend who swears that hypnotherapy helped her quit smoking, or a partner who (lucky for you) sought EFT (Emotionally Focused Therapy) to help them with their avoidant attachment style. As you explore different therapists, it's helpful to know what perspective resonates with you based on the type of support you're looking for. Regardless, no psychotherapy style is one-size-fits-all, and no therapist can "heal" you quickly. All ways of working take time, patience, and long-term effort. I've put together a list of what I would consider to be the more "trendy" or popular current therapy modalities.
CBT – Cognitive Behavioural Therapy
If you're just being introduced to the world of therapy, CBT might be one of your first introductions to this world. Your doctor might have recommended you seek CBT after diagnosing you with GAD (Generalized Anxiety Disorder) or MDD (Major Depressive Disorder), two common disorders that can be diagnosed by a family physician here in Canada. "CBT is the gold standard," you might hear people say. It was developed in the 1960s by Dr. Aaron T. Beck, based on the notion that negative thoughts can result in negative feelings and behaviours. The approach is structured and focuses largely on identifying and working with automatic thoughts to help people change their thinking patterns.
The downside? I've had many clients tell me that CBT was helpful in some ways, but that it felt invalidating to label certain thoughts as "irrational," and that the treatment was limited in how much meaningful, long-term change was able to take place. So when would it be appropriate to seek out a CBT-oriented therapist? If you have limited time and resources and would like structured help overcoming specific concerns. If you're not ready to go deep and would prefer staying more manualized, structured, and focused on the present moment. It can also be very helpful for conditions rooted in distorted thinking, like OCD, for example. I will often use a CBT perspective when working with a client experiencing OCD-related symptoms.
Psychodynamic Therapy
Psychodynamic therapy is a modern offshoot, or umbrella term, based on the psychoanalytic perspective. When thinking about psychoanalysis, you might envision lying down on a couch, Tony Soprano's exploration of his sociopathic tendencies, or the spectacular gaze of Dr. Orna Guralnik on the show Couples Therapy. Psychodynamic therapy is the oldest form of psychotherapy, developed in the 1890s, and it's based on free association (saying whatever comes to mind), and working with a therapist who will help you untangle and make sense of how you're getting in your own way (we call these defences).
What makes psychodynamic psychotherapy distinct? The acknowledgement and emphasis on the unconscious—the idea that things outside of our awareness might be influencing our daily thoughts, behaviours, and overall emotional experience. The research on psychodynamic therapy is promising and significant, with patients continuing to improve even after treatment has ended. In fact, some clinicians believe that the success of other therapies often relies on an unintentional use of psychodynamic techniques and perspectives (a hot take, but I tend to believe this). With the goal of long-term relief, one of the difficult aspects of psychodynamic treatment is that it can, and often does, take time, posing a financial barrier for many.
IFS – Internal Family Systems
IFS (Internal Family Systems) was developed by Richard Schwartz in the 1980s. The model proposes that the mind consists of different "parts" or sub-personalities that interact with one another and become more prominent at different times. Within the IFS model, some of the commonly explored parts are called Firefighters, Exiles, and Managers. Many people find this way of understanding themselves compassionate and intuitive because it encourages curiosity rather than self-criticism. Like any therapy approach, it resonates deeply with some people and less so with others.
EMDR – Eye Movement Desensitization and Reprocessing Therapy
EMDR is a treatment approach that uses bilateral stimulation, often through guided eye movements, to help the brain process distressing traumatic memories. A supervisor once described it to me as being similar to developing a photographic negative (if you're old enough to remember film photography), where the image gradually loses some of its intensity and vividness. The memory remains, but it often feels more distant and less emotionally overwhelming.
This might feel like exactly what you need, while others might prefer to work with difficult memories differently, by making sense of them, finding meaning, and developing the capacity to view them from a different perspective. EMDR is generally a short-term treatment and can be especially beneficial for PTSD, particularly if you have limited time or financial resources. The traumatic experience doesn't necessarily need to be described in detail, which can also feel safer for some people. Although EMDR has a strong evidence base, particularly for PTSD, researchers continue to study exactly how it produces its therapeutic effects.
References
https://cares.beckinstitute.org/about-cbt/history-of-cbt/
https://www.psychologytoday.com/ca/therapy-types/internal-family-systems-therapy
https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy
