What Kind of Therapy Do I Need?
Therapy Alphabet Soup:
CBT, MB-CBT, TF-CBT, ACT, HRT, ERP, EMDR, IFS, IPT, & 249+ more.
All the acronyms, jargon, and honestly, probably a lot of psychobabble can make it for the average person to know what they should be looking for when it comes to finding a therapist. In fact, some have argued that psychology faces a “theory crisis:” there are many theories of poor quality and people keep creating more instead of improving and validating existing ones (Eronen & Bringmann, 2021). It's difficult to provide an exact number because there are so many and quite a few are similar, overlapping with each other. I was able to count 259+.
Here are nutshell summaries of some of the more common theories and interventions.
Cognitive Behavioral Therapy (CBT): A therapy that focuses on changing negative thoughts and behaviors. CBT helps people recognize and challenge their negative thinking and replace it with positive, more productive thinking.
Mindfulness-Based Cognitive Behavioral Therapy (MB-CBT): Combines CBT with mindfulness practices.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): A form of CBT specifically designed to treat trauma, using exposure therapy and relaxation techniques.
Acceptance and Commitment Therapy (ACT): ACT encourages clients to accept and be present with their thoughts and feelings rather than fighting against them while orienting the client to their values.
ACT-Enhanced Habit Reversal Therapy (ACT/HRT): Combines ACT with HRT (see below) to treat unwanted habits or behaviors.
Habit Reversal Training (HRT): HRT helps clients break unwanted habits or behaviors, such as hair pulling or nail biting, through behavioral techniques including awareness training, relaxation, and competing responses.
Exposure and Response Prevention (ERP): Used to treat certain anxiety disorders and obsessive-compulsive disorder (OCD). ERP involves exposing clients to feared situations or objects while preventing them from performing their usual compulsive behaviors. Clients learn to tolerate anxiety.
Eye Movement Desensitization and Reprocessing (EMDR): EMDR involves focusing on traumatic memories while engaging in eye movements.
Internal Family Systems (IFS): Views people as having multiple "parts" or sub-personalities and helps them develop a more compassionate relationship with themselves.
Interpersonal Psychotherapy (IPT): Focuses on improving communication and relationships with others.
Dialectical Behavior Therapy (DBT): A form of CBT that combines mindfulness and behavioral techniques to help clients manage intense emotions, improve communication, and relationships.
With so many different acronyms and theories, it can be hard to know what to choose or look for.
What Really Matters In Therapy? The Common Factors.
The common factors (Wampold & Imel, 2015) refer to the elements of therapy that are shared across different therapeutic approaches and have been found to be effective in producing positive outcomes. Some of these include:
Therapeutic Alliance: The relationship between the therapist and the client, including trust, rapport, and collaboration.
Client Factors (i.e., what you bring to the table): Factors such as your motivation, willingness to change, openness to therapy, and clear goals.
Expectations: Your belief in the effectiveness of therapy and the positive effects of receiving treatment.
Overall, what makes therapy effective is a combination of these common factors and the individual therapist's expertise, as well as the client's unique needs and circumstances. Effective therapy is often characterized by a collaborative relationship between the therapist and client, a focus on the client's strengths and resources, and an approach that is tailored to the client's specific goals and needs.
Does This Mean Anything Goes In Therapy?
No. While there are common factors across counseling orientations that tend to produce positive outcomes in therapy, it would be a mistake to think that any counseling orientation can treat any presenting concern.
Therapists should not use the common factor research as an excuse not to have a solid theoretical orientation or treatment plan. Having a theoretical base can help guide treatment and monitor progress. It’s easy for therapists to fall into a trap of not really providing treatment. Sessions may go:
Therapist: “Hey how was your week?”
Client: “It was blah, blah, blah.”
Therapist: “Ok, great. See you next week, same time?”
A good therapist should help you keep track of your goals and reasons for coming to therapy. For change to occur in your life, your circumstances have to change, or your behavior has to change. So what type of treatment do you need?
Specific Treatments for Specific Concerns
The more specific your concern, the more likely you are to need a specific form of therapy or a specialist with training or experience in that area.
Exposure-based therapies to treat problems like trauma (e.g., TF-CBT) and OCD, panic disorders, and phobia (e.g., ERP).
Habit reversal training (HRT) is the most effective treatment for body-focused repetitive behaviors (Skurya et al., 2020; e.g., trichotillomania, nail biting).
ACT or CBT (or any major theoretical orientation) to treat common concerns like depression, anxiety, interpersonal relationships, adjustment disorders, and life transitions.
Choosing a Therapist: Speciality Areas
If your concerns are centered around specific certain life milestones or decisions (e.g., making a career shift, marriage, etc.), exploring different parts of yourself or identities (e.g., sexual orientation or gender identity), drug and alcohol abuse, then you may find specialists in your specific area of concern: career counseling (many universities offer post-graduation career counseling services), gender therapy from a gender specialist, LGBT+ affirming therapist, or drug and alcohol counselor or specialist.
If Most Therapies Are Equally Effective, Why Are You an ACT Therapist?
One of the reasons I have a preference for ACT is its theoretical parsimony. ACT makes fewer assumptions about constructs that could turn out to be false or inaccurate (e.g., a lot of hypothesized mental constructs can’t be directly measured or are better explained by more concrete behavioral terms and environmental circumstances). In other words, ACT more closely adheres to Occam's Razor than most counseling orientations. ACT focuses on key processes common to most effective therapies (e.g., mindfulness and related to our thoughts in different ways, which ACT relabels defusion). ACT can also help orient therapists in setting behavioral, value-based, goals with their clients.
Trying To Find a Las Vegas Therapist or Online Psychologist?
You can learn more about my background and credentials on my About Me page. I serve Las Vegas, NV, and Nevada statewide as well as Portland, OR, and all of Oregon statewide (in addition to 33+ PsyPACT states) via teletherapy. You may call me at (702) 530-6134, schedule an initial consultation, or use the contact form to take the first step.
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Burbridge-James, W., & Iwanowicz, M. (2018). Psychotherapeutic interventions and contemporary developments: Common and specific factors. BJPsych Advances, 24, 54-65. https://doi.org/10.1192/bja.2017.24
Eronen, M. I., & Bringmann, L. F. (2021). The theory crisis in psychology: How to move forward. Perspectives on Psychological Science, 16, 779-788. https://doi.org/10.1177/1745691620970586
Fitzpatrick, S. (2006, July 18). Simplicity in the philosophy of science. In Internet Encyclopedia of Philosophy. Retrieved March 23, 2023, from https://iep.utm.edu/simplici/#SH1a
Skurya, J., Jafferany, M., & Everett, G. J. (2020). Habit reversal therapy in the management of body focused repetitive behavior disorders. Dermatologic Therapy, 33, e13811. https://doi.org/10.1111/dth.13811
Tavris, C. (2015). Psychobabble and biobunk: Using psychology to think critically about issues in the news (3rd ed.). Pearson.
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. Routledge.
