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Understanding therapy options

Once you’ve found a therapist, you’ll usually be asked what approach you’re looking for – or offered one without much explanation of what it actually involves.

Here’s what the most common approaches are like in the room, so you’re choosing with some idea of what to expect rather than guessing from an acronym.

Talking therapies you’re likely to be offered

These aren’t rival schools competing for the “right” answer – they’re different tools, and which one suits you often depends more on what you’re bringing to it than which is objectively best.

  • CBT (cognitive behavioural therapy) is structured and present-focused – identifying patterns in thoughts and behaviour that keep a problem going, and building practical ways to shift them. Often time-limited, with things to try between sessions.
  • Counselling is usually shorter-term and centred on a specific issue – a bereavement, a relationship ending, a difficult decision – giving you space to talk it through with someone trained to listen well.
  • Psychodynamic or psychoanalytic therapy looks further back, exploring how past experiences and relationships shape present patterns. Usually less structured than CBT, and often longer-term.
  • EMDR (eye movement desensitisation and reprocessing) is used mainly for trauma and PTSD, using guided eye movements or taps while recalling difficult memories to help the brain process them differently.
  • Integrative or eclectic therapy draws on several approaches rather than sticking to one model, adapted to what you specifically need.

None of these require you to arrive with a diagnosis or the right vocabulary – a good therapist will help you work out what fits once you’re actually talking.

What might suit you…

  1. Want something structured, with clear tools to practise? CBT tends to suit people who like a plan and visible progress markers.
  2. Working through one specific, recent issue? Counselling is usually the right weight for something bounded, rather than a longer excavation.
  3. Feel like the same pattern keeps resurfacing across different situations? Psychodynamic therapy is built for exactly that kind of repeating pattern.
  4. Dealing with a specific traumatic memory or event? EMDR is worth asking about directly – not every therapist offers it, so you may need to search specifically for one who does.
  5. Not sure, or your situation doesn’t fit neatly into one box? Say that plainly in a first conversation – a good therapist will help match the approach to you, not the other way round.

It’s fine to ask before you commit

You don’t need to already know which approach you want before booking. Most therapists are used to explaining their approach on a first call, and switching if it’s not landing partway through isn’t a failure on your part – it’s useful information about what you actually need.

If a few sessions in, the approach doesn’t feel right, that’s worth raising directly – a good therapist would rather adjust than have you quietly disengage.

Worth knowing

NHS Talking Therapies mostly offers CBT and guided self-help, with some counselling for depression – if you specifically want psychodynamic therapy or EMDR, private practice or a charity service is more likely to offer it. See NHS Talking Therapies and Finding a therapist for the practical routes into each.

Recommended reading

Jeffrey and Minnie Wood’s Therapy 101 is the plain-English starting point – a walk through the different kinds of therapy and mental health professionals, written for general readers rather than clinicians.

For something that shows rather than explains, Philippa Perry’s Couch Fiction is a graphic novel by a UK psychotherapist depicting a full course of psychodynamic therapy panel by panel – a genuinely different way to get a feel for what one approach is actually like in the room.