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Why the obvious match isn’t always the right one
A common way to choose a therapy is to look for one that seems to fit your personality. If you think of yourself as analytical, a structured, logical Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder appeals. If you’re more led by feeling, an approach built around emotions does. What’s known about matching people to therapies comes from a limited number of studies, and none of it can tell any one person what will work for them. It does show where that instinct is a good guide, and where it’s a rough one.
Starting with what appeals to you
Going with the approach that appeals to you has research behind it. Across 53 studies, people who got the kind of therapy they preferred were less likely to drop out. They also did somewhat better than people who got something they hadn’t chosen (Swift and colleagues, 2018).
What sounds most like you is a reasonable place to start. It just isn’t a reliable guide on its own.
What research has found about matching
The traits with the clearest matching evidence aren’t the ones people usually go by.
One is how people respond to being directed. People who strongly resist being told what to do tended to do better with a therapist who followed their lead and reflected back. A therapist who took charge and gave direction suited them less well (Beutler and colleagues, 2018, on being directed).
Another is how people cope when things are hard. Some tend to turn inward: going quiet, going over it, being hard on themselves. They generally did better with therapy focused on understanding where patterns come from (Beutler and colleagues, 2018, on coping style). Others tend to turn outward: staying busy, acting quickly, getting frustrated with the people or situations around them. They generally did better with therapy focused on symptoms and practical skills.
Both findings are about how a therapist works, rather than which therapy they practise. Within many different approaches, a therapist can choose to follow your lead or give direction, and to look at patterns or build skills.
If you’re someone who thinks things through
Therapists often notice something about people who are very good at explaining their own difficulties. Understanding the problem doesn’t always change how it feels. Thinking it through can sometimes become a way of keeping the feeling at a distance.
Going against type isn’t a reliable answer either. In one small trial, therapy built around people’s existing strengths led to faster improvement than therapy built around what they found hardest. Neither matching your style nor working against it is a rule.
Some approaches work with what you feel as it happens in the session. Examples include the imagery work in schema therapy, and somatic therapy, which works with what you notice in your body.
What to do with this
Start with an approach that appeals to you. After a while, notice whether it’s changing how things feel, not only how well you understand them. If you can explain a pattern clearly and it still feels the same, that’s worth raising with your therapist, and why therapy stalls covers what that can point to.
It also helps to tell your therapist how you like to work, including whether being given direction tends to put your back up. Many therapists can give more structure or leave more room for you to lead.
Whichever approach you choose, how well you and your therapist work together tends to matter more than the method. Why who you see matters more than what they do explains why.
If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.
Where next
What therapy actually is covers how the main approaches differ. For two of them side by side, see cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) compared.