What Makes A Therapy Modality Successful?

Over 41.7 million US adults see a therapist. With so many people in therapy, it’s likely you have heard a therapy success story from someone in your family or community. Still, not everyone finds success in therapy right away. Factors like incompatibility with a therapist or financial challenges can impact how beneficial therapy is for your emotional health. 

In some cases, a therapist might not be practicing a modality that is effective for the individual’s symptoms. Different therapists may take different approaches during their therapy sessions. Thus, it could be beneficial to investigate some of the common modalities therapists can specialize in so you have a sense of what to expect before reaching out for a consultation.

If you choose to work with an integrative therapist, they might take theories from several approaches to tailor your treatment plan to your specific symptoms. If parts of one modality don't work for you, you might try another. To understand these concepts further, it can be helpful to identify the categories used to classify each of these modalities. 

Organizing each into a category

To organize over 400 therapeutic modalities that one might use, psychologists group these modalities into six approaches. These include the following:

Psychoanalysis and psychodynamic therapies: Overview

Psychoanalysis and psychodynamic methods often involve discovering a client's unconscious thoughts and motivations and focusing primarily on self-reflection and understanding. 

Behavioral therapy

Behavioral therapy is a therapeutic process that involves changing behaviors to change thought processes, symptoms, and emotions. This approach may focus on the present instead of the past.

Cognitive therapy examines why an individual might think the way they do by breaking down beliefs and examining both past and present. Cognitive treatment is often combined with behavioral treatment in this CBT model. 

Humanistic therapy involves centering on a client, learning mindfulness and sensory awareness, and searching for meaning. Humanistic practitioners may remind clients of their common humanity with others and help them discover meaning in life. 

Integrative therapy takes approaches from multiple modalities to support clients. Integrative therapists may examine the client’s needs and discuss a treatment plan accordingly.

Alternative therapy may involve non-talk therapy methods or combine talk therapy with other activities like art, music, dance, or massage. 

Modalities to consider

Although all 400 modalities are not listed below, clients can consider a few popular types of treatment and research options available in their area. Below are several research-backed options available to try. 

Cognitive-behavioral therapy is often considered "the gold standard" of psychotherapy in the US. It is one of the most widely studied and practiced modalities in this field. CBT focuses on helping clients reflect on their thoughts and beliefs and better understand how those thoughts and beliefs relate to behaviors and challenges. 

Cognitive restructuring isn’t usually the only tool of a CBT counselor. They may also use techniques like roleplaying, self-care practice, worksheets, and motivational interviewing. CBT is most commonly used to treat anxiety and depression. Studies show that this approach can reduce symptom severity and offer behavioral and cognitive strategies for symptom management. 

Internal family systems (IFS)

Internal family systems therapy (IFS) is a type of counseling often used for those who have experienced childhood trauma. It uses the family systems theory to showcase how individuals function based on their place in the family system. Adults may practice IFS by understanding how their personality has developed to cope with trauma. According to this IFS theory, each person has different subpersonalities. Each part might take on a different role such as working, safeguarding your family, experiencing emotions, or expressing individuality, for example. 

According to a recent study, IFS is associated with reduced PTSD symptom severity over time and a decrease in depression, dissociation, and dysregulation. At a one-month follow-up of the study, 92% of participants no longer met the criteria for PTSD. 

Eye movement desensitization and reprocessing (EMDR) 

Eye movement desensitization and reprocessing therapy (EMDR) was developed to treat PTSD. However, it can also be used for anxiety and depression. EMDR uses bilateral brain stimulation to help clients discuss traumatic memories or symptoms without emotionally processing them or retraumatizing themselves. A counselor may use a light, hand movement, or hand buzzers to stimulate both sides of your brain as you talk. 

Art may be an effective treatment for those who struggle to express emotions verbally. In an art therapy session, your therapist can provide materials to create any piece of art you're interested in. In some cases, a counselor may offer prompts or create art alongside the client. 

While you work on your art piece, your therapist can provide talk counseling, music, or silence, depending on your needs. If you're attending therapy for a specific goal, you and your therapist might work on projects that can help you visually express what you felt in certain situations or how the symptoms of a mental health condition impact you, for instance. 

Alternative therapies

There are many types of alternative treatments you might try that can combine non-talk-therapy with psychotherapy approaches to form a comprehensive wellness plan. Examples may include the following: 

• Massage
• Animal-assisted
• Acupuncture
• Gardening
• Reiki or energy work
• Religious counseling 
• Psychodrama
• Equine
• Water
• Wilderness
• Dance 

Dialectical behavior therapy (DBT) is a type of behavioral modality that may work well for clients experiencing distressing or intense emotional reactions or difficulty setting boundaries. Initially developed for treatment of borderline personality disorder (BPD), DBT involves a workbook and structured treatment plan designed for healing around four core concepts: 

• Mindfulness 
• Emotional control
• Distress tolerance
• Interpersonal effectiveness

Through a DBT group or individual session, clients can progress through the workbook with advice from their therapist. They may be asked to complete daily diary cards and/or complete worksheets after sessions. DBT modules discuss ways to practice mindfulness, communicate healthily with others, practice a self-care routine, and cope with significant distress and change. DBT is an intensive, short-term treatment that has been proven successful in managing personality disorders. 

Exposure and response prevention (ERP)

Exposure and response prevention therapy (ERP) is often used alongside CBT to treat specific phobias, obsessive-compulsive disorder (OCD), eating disorders, or other anxiety disorders. It involves exposure and desensitization to fears, compulsions, or distressing thoughts. The desired outcome for patients is to make these phobias or disorders less impactful and to provide guidance and coping mechanisms for facing stressful situations. 

How to find the most effective modality for you

When evaluating modalities or services, you may want to consider your goals for treatment. You can ask yourself the following questions after your first few therapy sessions: 

• Has this therapist listened to my goals? 
• Do I align with the treatment approach outlined to me? 
• Do I agree with the notes and outcomes written in my therapy treatment plan? 
• Do I feel comfortable being vulnerable with this therapist?
• Do I feel safe in therapy? 
• Is my therapist's personality compatible with mine? 
• Does my therapist understand and respect my identity?
• Does my therapist respect my wishes to identify with a diagnosis I've been given in the past?
• Do I like this therapist as a person? 

Note that in many cases, you can decide to change your therapist at any timeand for any reason. If you don't feel comfortable with a therapist's approach, you feel like the connection is wrong, or don't feel compatible with their personality after several sessions, you may search for a new provider. 

If you can answer all the questions above with a "yes", you might experience success over time. However, answering many or all the questions with a "no" or "maybe" could signify that your therapist or treatment modality isn't currently working for you. Talk to your therapist about these questions in further detail to see whether you might benefit from finding a new provider or taking a new approach in therapy. 

Flexible counseling options 

Some people may face difficulties finding a provider that’s a good fit for their needs due to treatment barriers like cost, availability, or insurance coverage. In these cases, working with a licensed therapist or psychiatry professional through an online platform like BetterHelp might be preferable. 

Online counseling can be more cost-effective and flexible compared to traditional counseling. With remote treatment, you might also be able to note which modalities you're interested in before you start. Additionally, online platforms often allow you to change your provider if your current therapist doesn't meet your needs. 

Evidence shows that specific modalities such as internet-based CBT, for instance, can effectively achieve successful treatment of multiple mental health conditions, including depression, anxiety, and social anxiety. However, you can also find modalities like DBT, EMDR, and IFS online. With nearly four out of ten Americans using online therapy, this format is practical, convenient, and popular.