Why there are so many types of therapy

Different therapies come at the same difficulties from different directions. Most are aiming for the same thing: for life to feel and go better. They differ in where they start, and how they get there.

Why there are so many

Different therapies have developed from different ideas about where difficulties come from and how people change. Some were built in response to perceived gaps in other therapies. Others came from adapting an existing therapy in the belief that it would work better for a specific difficulty. Acceptance and commitment therapy (ACT) A practical talking therapy, said as the word "act". It helps you live well alongside hard thoughts and feelings, instead of waiting for them to go away first. More in the jargon decoder (ACT) grew out of Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder (CBT). Schema therapy A longer-term talking therapy that works on deep, long-standing patterns. A schema is a deep belief about yourself and other people, formed early, that shapes how you read situations. More in the jargon decoder kept the structure of CBT and added work on early experience and emotion. Psychodynamic therapy A therapy that looks at the parts of your life you can't quite see from the inside. Its core idea is that a lot of what shapes how you feel and act sits outside your awareness, and was laid down early. More in the jargon decoder grew out of psychoanalysis, and it has changed a great deal since. Narrative therapy A therapy built on one principle: you are not the problem, the problem is the problem. It works on the story you tell about your life, including what that story leaves out. More in the jargon decoder is one of the few therapies to have come out of Australia.

Where different therapies start

One way to understand the differences is to look at where each therapy starts.

Starting from thoughts and actions

Cognitive behavioural therapy. A structured, practical form of talking therapy, built on a simple idea: what you think affects how you feel, and both affect what you do.
Behavioural activation. Works on what you do. You and your therapist look at what a week actually contains, then plan specific things back into the week.
Acceptance and commitment therapy. Helps you live well alongside hard thoughts and feelings, instead of waiting for them to go away first.
Dialectical behaviour therapy (DBT). For people whose emotions come on hard and fast. It teaches practical skills, in a set order, for staying present, getting through a crisis, managing strong emotions and handling other people.
CBT for attention deficit hyperactivity disorder (ADHD). A version of CBT adapted for ADHD, focused on day-to-day organisation and self-management.

Starting from feelings and the relationship

Person-centred therapy. You set the agenda, and your therapist follows where you go. The therapy rests on the idea that being properly heard, by someone who isn’t judging you, is itself the treatment. Carl Rogers developed it in the United States from the 1940s.
Compassion-focused therapy. Developed for people with a lot of shame and self-criticism. It helps you build a supportive, caring relationship with yourself in place of a blaming, critical one.
Internal family systems (IFS). Starts from the idea that your mind isn’t one voice. It treats having different parts as normal, and works with those parts directly.

Starting from the past and what’s outside your awareness

Psychodynamic therapy. Looks at the parts of your life you can’t quite see from the inside. Its core idea is that a lot of what shapes how you feel and act sits outside your awareness, and was laid down early.
Schema therapy. A longer-term therapy for deep, long-standing patterns. A schema is a deep belief about yourself and other people, formed early, that shapes how you read situations.

Starting from your story

Narrative therapy. Built on one principle: you are not the problem, the problem is the problem. It works on the story you tell about your life, including what that story leaves out.

Starting from the body

Somatic therapy. Talking therapies that pay close attention to the body. They work less with what you think about something and more with what your body does when it comes up.

Starting from a memory

Eye movement desensitisation and reprocessing (EMDR). For memories that still feel raw. You bring a painful memory to mind for short stretches while your attention is split, usually by following your therapist’s hand from side to side. EMDR (eye movement desensitisation and reprocessing) A structured therapy for memories that still feel raw. You bring a painful memory to mind for short stretches while your attention is split, usually by following your therapist's hand as it moves from side to side. The aim is for the memory to become less upsetting. More in the jargon decoder was developed in the late 1980s.
Trauma-focused CBT. A family of talking therapies that work directly on the memory of something that happened, using the ideas of CBT.

A medication alongside therapy

One 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 works differently from all the others, because a medication is part of the treatment.

Psychedelic-assisted therapy. A treatment overseen by approved Psychiatrist A medical doctor who has specialised in mental health. Psychiatrists can diagnose, prescribe and do therapy, though many spend most of their time on medication and diagnosis rather than weekly sessions. More in the jargon decoder , where a measured dose of a psychedelic drug is given to support psychological treatment. In Australia it’s rare and expensive, and it isn’t a first option.

Other approaches you may come across

We don’t have pages on these yet, but you may see them on therapists’ websites.

Exposure and response prevention (ERP) A kind of CBT for obsessive compulsive disorder (OCD). You gradually face the things that set off your anxiety, then hold off on the checking, washing or asking for reassurance you'd normally do to bring the anxiety down. More in the jargon decoder . A style of CBT for obsessive compulsive disorder (OCD). You gradually face the things that set off your anxiety. Then you hold off on the checking, washing or asking for reassurance you might normally do to reduce your anxiety.
Interpersonal therapy. A short, structured therapy first developed for depression. It works on the links between how you feel and what’s happening in your relationships and your life, such as grief, conflict with someone close, or a big change in your circumstances. It was designed to run for 12 to 16 weekly sessions (International Society of Interpersonal Psychotherapy), and it’s on Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder ’s list of approaches for a Mental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder .
Mindfulness-based cognitive therapy. Combines Mindfulness Paying attention to what's happening right now, including what you feel, without being pulled into the past or the future, and without acting on it straight away. Several therapies teach it, including ACT and DBT. More in the jargon decoder training with parts of CBT, usually taught in a group over eight weeks, for people who’ve had depression before and want to stay well (Rycroft-Malone and colleagues, 2017). A review of nine trials found it lowered the chance of depression coming back over the following year or so (Kuyken and colleagues, 2016).
Solution-focused brief therapy. Short and goal-focused. It concentrates on what you want to be different and what’s already working, more than on where the problem came from. A 2024 review of 25 earlier reviews found it helped with a range of difficulties, but said more careful research is still needed (Zak and Pekala, 2024).
Couples and family therapy. Works with two or more people together, on what happens between them. If there’s violence, fear or control in a relationship, couples therapy isn’t a safe place to start, and 1800RESPECT is on 1800 737 732.

Many of these therapies can also be done in a group, which is a way of running therapy rather than a type of therapy.

Some therapies start in more than one place, and many therapists combine approaches, so treat these groups as a rough map.

Thinking-led and body-led

Some people describe therapies as working from the top down, starting with thoughts and understanding, or from the bottom up, starting with the body and feelings. That’s a handy way to picture the differences. It isn’t a scientific grouping, and most therapies do some of both. Compare the therapies sets them side by side.

Does the type of therapy matter?

For most difficulties, no single approach consistently beats the others (Cuijpers and colleagues, 2023).

There are exceptions. For post-traumatic stress disorder (PTSD), the therapies that work directly on the memory did best, and counselling that didn’t focus on the trauma helped less (Mavranezouli and colleagues).

In depression trials, non-directive supportive counselling came out behind other approaches. It still helped people more than no treatment, but it produced smaller gains than more structured methods. In those trials, that counselling was a basic comparison: a therapist offering warmth and attention while deliberately holding back any active tools. It isn’t the same as Person-centred therapy A therapy where you set the agenda. Your therapist follows where you go and stays with it, on the idea that being properly heard, by someone who isn't judging you, is itself the treatment. More in the jargon decoder as it’s practised.

Researchers still disagree about why most therapies do about as well as each other. One view is that therapies work mainly through what they have in common. That means a real relationship with someone who takes you seriously, an explanation of what’s going on that makes sense to you, and a plan that gets you doing things that help. On this view, each therapy’s own methods matter because they give you something useful to do, more than because they’re uniquely right for your difficulty. When therapies are compared directly, the differences between them are usually small (Wampold, 2015).

Other researchers say the evidence can’t settle this yet. A 2019 review concluded that it’s still unknown whether therapies work mainly through what they share, through what makes each one different, or through both (Cuijpers and colleagues, 2019).

Whatever the approach, the relationship with your therapist matters a great deal. Why who you see matters more than what they do explains why.

Choosing an approach

You can’t try out every therapist, so knowing which approaches suit how you like to work helps narrow the field. But the approach that sounds most like you isn’t always the one that helps most. Why the obvious match isn’t always the right one explains why.

When you’re looking, ask each therapist how they work. Questions to ask a therapist has ways to ask. Why therapists work in different ways covers why two therapists can offer quite different things.

Where next

The guide asks how you like to work, alongside what you’re dealing with and what you’ve tried. If you’re not sure therapy is what you want, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try.