Therapy, Explained: A Guide to the Approaches We Use and Who They Help
Finding the right therapy approach can feel confusing. Here's what the different modalities actually mean.
If you've ever looked at a therapy website and wondered what the difference is between CBT, DBT, ACT, IFS, narrative therapy, and everything else, you're not alone.
Therapy comes with a lot of terminology, and it isn't always obvious what those terms mean—or whether a particular approach makes sense for what you're experiencing.
The good news is that you don't need to become an expert in every therapy modality before making an appointment. A therapist's approach is one part of the picture. Your concerns, goals, personality, identity, past therapy experiences, and relationship with your therapist also matter.
At Circle in a Square Counseling, we use a range of evidence-based and integrative therapy approaches to support clients across Washington State. Our clinicians work with children, adolescents, adults, couples, and families and provide care for concerns including anxiety, depression, trauma, PTSD, grief, burnout, relationship challenges, identity exploration, OCD, eating disorders, and more.
Here's a closer look at some of the approaches you may encounter when looking for therapy.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy, or CBT, is one of the most widely used approaches in mental health care. It focuses on the relationship between thoughts, emotions, and behaviors.
The basic idea is that patterns of thinking and behavior can influence how we feel—and changing those patterns can sometimes help change how we experience difficult situations.
A therapist using CBT might help a client identify an unhelpful thought pattern, examine the evidence behind it, and practice responding to the situation differently.
CBT is commonly used for concerns such as anxiety and depression, and research has also supported its use across a range of other mental health conditions.
The American Psychological Association provides an overview of cognitive behavioral approaches and how they can be used in treatment.
CBT may be particularly appealing to people who like having concrete strategies to practice between sessions. That doesn't mean therapy has to feel clinical or rigid, though. The way CBT is used can look very different from one therapist to another.
Dialectical Behavior Therapy (DBT)
Despite its name, Dialectical Behavior Therapy isn't about debating or arguing.
DBT was developed to help people manage intense emotions and build skills for navigating difficult situations. It combines acceptance with the idea that change is possible.
DBT commonly focuses on skills related to emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness.
A therapist might help someone recognize when their emotions are escalating, develop strategies for getting through moments of distress, or communicate more effectively in relationships.
The National Institute of Mental Health includes DBT among the psychotherapies used to treat mental health conditions, and the approach has been extensively studied, particularly in relation to borderline personality disorder and suicidal behavior.
DBT skills can also be useful for people dealing with emotional overwhelm, relationship difficulties, impulsivity, or difficulty managing intense reactions.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy, or ACT, takes a somewhat different approach to difficult thoughts and emotions.
Rather than trying to eliminate every uncomfortable feeling, ACT focuses on learning how to make room for difficult internal experiences while taking actions that align with your values.
For example, someone with anxiety might spend a lot of energy trying to avoid situations that make them uncomfortable. ACT may help them recognize anxious thoughts without allowing those thoughts to completely determine their choices.
ACT incorporates mindfulness, acceptance, values, and behavior change.
The Association for Contextual Behavioral Science provides additional information about ACT and its underlying framework.
ACT can be useful for people who feel stuck in cycles of avoidance, self-criticism, worry, or attempts to control thoughts and emotions.
Internal Family Systems (IFS)
Internal Family Systems, often called IFS, views the mind as containing different "parts" that can have different emotions, perspectives, and protective roles.
You might recognize this experience without realizing it. One part of you wants to make a change while another part is afraid. One part wants to speak up while another immediately tells you to stay quiet.
IFS provides a framework for exploring these internal experiences with curiosity rather than judgment.
For some clients, this approach can be a useful way to explore trauma, identity, relationships, emotional patterns, and internal conflict.
IFS is different from approaches such as CBT and DBT, and the research base is still developing. The National Center for Complementary and Integrative Health is one useful resource for understanding how different complementary and integrative approaches fit into the broader mental health landscape.
Person-Centered, Humanistic, and Existential Therapy
Sometimes therapy isn't about learning a specific set of skills. Sometimes people need a space where they can slow down, understand themselves, and explore what they actually want from their lives.
Person-centered therapy emphasizes empathy, authenticity, and the therapeutic relationship. Humanistic approaches generally focus on personal growth and the individual's capacity for change.
Existential therapy explores bigger questions about meaning, freedom, responsibility, identity, relationships, and what makes life feel purposeful.
These approaches may resonate with people who want therapy to be exploratory rather than highly structured or skills-focused.
They can also be particularly helpful when someone is navigating a major life transition, identity exploration, grief, relationship change, or questions about meaning and purpose.
Narrative Therapy
Narrative therapy looks at the stories people have developed about themselves and their lives.
That doesn't mean pretending difficult experiences didn't happen. Instead, narrative therapy can help people examine how they have come to understand themselves and whether those stories still serve them.
For example, someone might describe themselves as "a failure," "the difficult one," or "someone who always messes things up." Narrative therapy can create space to examine where those beliefs came from and identify other parts of the person's story that may have been overlooked.
The Dulwich Centre offers an extensive introduction to narrative therapy and its development.
This approach can be especially meaningful for people exploring identity, culture, relationships, trauma, or experiences of marginalization.
Somatic and Body-Based Approaches
Not everything we experience emotionally stays in our thoughts.
Stress can show up in the body through muscle tension, changes in sleep, racing heart, restlessness, fatigue, or feeling constantly on edge. For people who have experienced trauma, paying attention to physical responses can be an important part of understanding what they're experiencing.
Somatic and other body-based approaches incorporate awareness of physical sensations into therapy. Depending on the therapist's training, this might include grounding exercises, breathing practices, movement, or noticing how emotions show up physically.
These approaches are sometimes incorporated into trauma-informed therapy, anxiety treatment, and work around emotional regulation.
It's important to note that "somatic therapy" can refer to a variety of approaches, so clients should ask their therapist what specific methods they use and what training they have.
Mindfulness-Based Cognitive Therapy (MBCT)
Mindfulness-Based Cognitive Therapy combines mindfulness practices with elements of cognitive therapy.
Instead of automatically reacting to every thought, clients learn to notice thoughts and feelings with greater awareness. This can create some distance between having a thought and automatically believing or acting on it.
MBCT was originally developed in part to help prevent recurrent depression, and research has examined its use for depression and other mental health concerns.
The Oxford Mindfulness Centre provides an overview of Mindfulness-Based Cognitive Therapy and its development.
For some people, mindfulness-based approaches can provide useful tools for recognizing thought patterns, managing stress, and responding to difficult emotions more intentionally.
Art, Drama, and Expressive Arts Therapy
Not everyone processes emotions most effectively by talking.
Expressive approaches can incorporate art, writing, movement, drama, music, or other creative activities into the therapeutic process. Depending on the clinician and modality, creative expression may be used to explore emotions, identity, relationships, trauma, or experiences that can be difficult to put into words.
You don't need to consider yourself "artistic" to benefit from expressive therapy.
For children and adolescents in particular, creative approaches can also provide another way to communicate and explore experiences that may be difficult to explain verbally. The American Art Therapy Association provides more information about art therapy and its uses.
Therapy for Different Identities and Experiences
The modality a therapist uses is only part of finding the right fit.
For many clients, who their therapist is and how that therapist understands their experiences can be just as important.
At Circle in a Square Counseling, our clinicians support a diverse range of clients, including people who identify as LGBTQ+, queer, neurodivergent, multicultural, immigrant, and part of underserved communities. Our team also works with couples and families, children and adolescents, and clients seeking faith-based or spiritually integrated therapy.
We also provide support for people navigating polyamory and non-monogamous relationships, identity exploration, caregiver fatigue, high-achiever stress, developmental disabilities, eating disorders and body image concerns, domestic violence, and addiction through a harm-reduction framework.
Culturally responsive therapy means recognizing that a client's identity, culture, community, and lived experiences can shape how they understand mental health and what they need from care.
That can be particularly important for clients who have previously felt misunderstood, stereotyped, or dismissed in healthcare settings.
So, Which Therapy Approach Is Right for You?
There isn't a single therapy modality that works for everyone.
A person experiencing anxiety might benefit from CBT, ACT, mindfulness-based therapy, or another approach. Someone processing trauma might incorporate narrative, somatic, expressive, or other trauma-informed methods. Someone navigating relationship concerns may benefit from individual or couples therapy depending on their circumstances.
And therapists don't necessarily stick to one modality in every session. Many clinicians integrate approaches based on the client's needs, goals, and stage of treatment.
The therapeutic relationship matters, too. The American Psychological Association notes that the relationship between therapist and client is an important part of effective psychotherapy.
So instead of asking, "Which therapy is the best?" it can be more helpful to ask:
What am I hoping to change, and what kind of support feels like a good fit for me?
A consultation with a therapist can help answer those questions.
Finding Therapy in Washington State
For people looking for therapy in Washington State, virtual counseling can make it easier to access care without adding a long commute or navigating the availability of a provider in your immediate area.
Circle in a Square Counseling provides virtual therapy across Washington State for children, adolescents, adults, couples, and families. Our clinicians use a range of therapeutic approaches to support clients with anxiety, depression, trauma, PTSD, grief, OCD, relationship concerns, burnout, identity exploration, life transitions, and other mental health needs.
Our goal isn't to put every client into the same treatment model. It's to connect people with clinicians and approaches that fit their experiences, concerns, and goals.
If you're considering therapy but aren't sure where to start, you don't need to figure out the modality on your own. Starting the conversation is often the first step toward finding care that fits.
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