How to Choose a Therapist: A Comparison of CBT, Humanistic Therapy, and Psychodynamic Therapy
Finding the ‘right’ therapist can feel overwhelming
Today, I’m sharing a few tips on choosing a therapist that suits your needs. I’ll also compare three popular therapy modalities — Cognitive-Behavioural Therapy (CBT), Humanistic Therapy, and Psychodynamic Therapy.
To begin, I will offer some general guidance on selecting a therapist and highlight key factors that lead to successful therapy outcomes.
Then, I’ll discuss the three modalities and cover some of their primary benefits and criticisms. To give you an idea of what you can expect, I’ll share a few examples of what each therapy might look like.
Image by Brooke Cagle
Getting started
First, I’d like to provide some general guidance on selecting a therapist of any modality.
You might want to start by considering the issue or issues that might lead you to seek out the help of a therapist. Some of the topics that can be brought to therapy include:
Anxiety or stress and related challenges, including sleep problems and physical symptoms
Depression and challenges with low moods
Not feeling ‘like yourself’
Struggling to manage strong emotions like anger, frustration, or guilt
Processing grief related to the loss of a loved one or a significant life change, such as the end of a relationship or the loss of a job
Experiencing challenges in your relationships
Struggling to accomplish your goals or create a life that feels right for you
Managing or dealing with physical problems such as pain, illness, or sexual issues
Understanding and overcoming obsessive problems or phobias
These are reasonable topics, thoughts, and feelings to bring to therapy (National Institute of Mental Health, 2021), and you are on the right track by seeking a therapist to help (UKCP, 2022).
A qualified therapist will support you to begin exploring these issues, and hopefully (Greenberg, Constantino and Bruce, 2006), you will get to a better place. All three modalities I’ll discuss could help you with any of these challenges, but the therapists of each modality will do it differently (UKCP, a).
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What are the ‘common factors’ in therapy?
You might expect me to jump in and describe the different modalities, expecting it to be the most critical factor for a successful outcome. Although it’s a good idea to consider the modality, it turns out that the quality of therapy outcomes is associated with a whole range of variables (Norcross, 2002).
Most of these aspects (85%) are not associated with the specific type of therapy. These include ‘common factors’ shared between different forms of therapy (30%), client expectancy (15%), and supporting factors in one’s life outside of therapy (40%). Only 15% of positive change is associated with the specific type of therapy one receives (Norcross, 2002). Knowing this may ease any pressure about choosing the ‘right’ modality.
The common factors that makeup 30% of the aspects leading to positive outcomes include elements found across different psychotherapy modalities. These are the therapeutic alliance, empathy, goal consensus and collaboration, positive regard and affirmation, mastery, congruence and genuineness, mentalisation and emotional experience (Nahum, Alfonso and Sönmez, 2018).
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Does the experience level of the therapist matter?
In addition to sharing what I know based on my professional experience, let me share some personal insight with you regarding the experience level of therapists. Before I started training as a therapist, I went for personal therapy. Over the years, I tried a few modalities, including the three I’ll discuss here.
Once, I started to see a very experienced therapist with extensive training, but it didn’t help me in the way I was hoping. Even after a few sessions, I didn’t feel like she understood me, and I noticed she seemed to want to talk about things that were not important to me.
Another time, I saw a less experienced therapist working in the same modality, and I had a much better experience. In this case, it seemed like the therapist understood me, and when she didn’t, she would ask more questions to clarify. I also felt it was safe to ask her questions when unsure of our direction. Even though it was sometimes challenging, it was much more helpful. I didn’t understand why this had been the case, and I even wondered if I didn’t ‘get’ what I was supposed to be doing with the more experienced therapist!
Now that I know more about how therapy works, I believe my experience was at least in part due to the common factors I described above. The other aspect that might have affected my experience was relational depth, a state of profound contact and engagement between people (Cooper, 2017). When I achieved this with the less experienced therapist, I became more comfortable and opened up more fully.
Although my personal experience might be helpful, it may also be useful to consider that research has shown that, in most cases, working with a more experienced therapist will not lead to a better outcome for the client (Goldberg et al., 2016). In some cases, seeing a more experienced therapist could be helpful. A meta-analysis found a relationship between therapist experience and positive outcomes for clients with depressive disorders and mixed internalising disorders, including anxiety, depression, and somatic symptoms (Walsh et al., 2018).
With all of these things in mind, my first suggestion is that once you have an idea of the therapist you might like to work with, make an initial appointment with at least one of the therapists and see if you feel comfortable with them (UKCP, b). Share an overview of the challenges you are experiencing. If the therapist does not think they can work with these issues, they should tell you, as they should only work within their competence (UKCP, 2019).
Next, let’s move on to some thoughts on the three modalities — CBT, Humanistic Therapy and Psychodynamic Therapy.
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About Cognitive-Behavioural Therapy (CBT)
Cognitive-Behavioural Therapy (CBT) focuses on the interplay of your thoughts, feelings, and behaviours within your social and environmental context (Fenn and Byrne, 2013). CBT is a time-limited, problem-oriented, and collaborative therapy (Fenn and Byrne, 2013). An average course of CBT therapy will last about 5 to 20 sessions, lasting about an hour, held weekly or fortnightly (BABCP, 2021).
One of the core concepts of CBT is that psychological issues are caused by distorted and dysfunctional thoughts leading to negative emotions and maladaptive behaviours (Gaudiano, 2008). CBT’s process will place your beliefs into three primary categories—self, others, and the future (Fenn and Byrne, 2013).
During a CBT session, you might work with the therapist to identify and challenge your thinking style, consider how you engage in activities during your day, and explore how you can increase your chances of enjoying and getting more from your life (BACP, 2022).
Although a CBT therapist may be interested in significant life events, especially those related to longstanding and complex problems (Butler, 2014), they will be less likely to explore past events than the other two therapists. They will instead focus on the present (Fenn and Byrne, 2013).
A CBT therapist may assign homework to you and suggest you do activities between sessions, including completing written worksheets that you will discuss with her during the sessions (Tang and Kreindler, 2017). An example activity is a thought record, a written exercise that uses a set of prompts to explore your thoughts and feelings in a specific situation. It can help you reflect on the evidence you might have to support or challenge some of your thoughts so you can consider if they are accurate and helpful (nhs.uk, 2022).
CBT is often labelled ‘evidence-based’, which can be misleading. Because it is a structured treatment, it is easier to study CBT than other non-structured therapies (Gaudiano, 2008), and it has been the focus of many clinical trials and meta-analyses that have demonstrated its efficacy (Hofmann et al., 2012). The label might seem like CBT might be the best choice of the three, but both humanistic psychotherapy (Elliott, 2002; Kate et al., 2023) and psychodynamic psychotherapy (Shedler, 2010; Steinert et al., 2017) have been proven effective through research. Although it has been proven effective, CBT doesn’t work for everyone, and in some cases, up to half of all participants do not recover fully from symptoms (Carter et al., 2013).
A criticism of CBT is that it is too mechanistic and does not consider the whole person (Gaudiano, 2008). Other criticism has debated whether it is possible to support effective change without considering a person’s developmental trajectory (Holmes, 2002). Others have wondered about the fundamental concept of questioning all negative thoughts as dysfunctional or maladaptive (Longmore and Worrell, 2007).
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About Humanistic Therapy
Humanistic therapy is the term for a larger category that contains multiple approaches, including person-centred therapy, Gestalt therapy, existential therapy, focusing-oriented–experiential therapy, emotion-focused therapy, solution-focused therapy, narrative therapy, and transactional analysis (Cain, Keenan and Rubin, 2016; House, Kalisch and Maidman, 2018).
Rather than focusing on problems and symptoms as a CBT therapist might (Fenn and Byrne, 2013), a humanistic therapist may seek to understand you as a whole person (Rowan, 2016). It considers that all humans are fundamentally OK and have the potential for growth throughout our lifetimes. A humanistic therapist may be curious about you emotionally, physically, spiritually, and creatively. Humanistic theories believe in free will and personal development (House, Kalisch and Maidman, 2018).
While CBT is directive (Fenn and Byrne, 2013), humanistic therapy is typically non-directive (Elliott et al., 2021), which means the therapist will focus on clarifying your thoughts and feelings instead of persuading you or offering encouragement or discouragement (Snyder, 1945). As humanistic therapy is not as problem-focused, it does not seek to fix you but to understand you so that you can continue on your journey of growth as a person (Schneider, Pierson and Bugental, 2014; Whitton, 2003).
You may be curious about the different modalities that sit within humanistic therapy. Instead of describing the sub-modalities, let me share how I perceive contemporary humanistic psychotherapy.
One way to look at it is to consider that humanistic therapists generally fall into two main camps stylistically—nurturing therapists and challenging therapists. I believe this is due to two strong characters in the development of humanistic therapy, Carl Rogers and Fritz Perls.
A therapist might draw from both camps, but they lean slightly more in one direction than the other. Therapists in each camp might even use the same humanistic theories but in different ways.
Nurturing therapists come from the lineage of psychologist Carl Rogers, the founder of person-centred therapy, also referred to as client-centred therapy (Rogers, 1942). The therapists in this camp tend to be warm and supportive. Person-centred therapy uses three core conditions—empathy, congruence and unconditional positive regard (Mearns and Thorne, 2013).
By practising unconditional positive regard (UPR), the therapist fully accepts the client without judgment. The client is safe to explore their thoughts, feelings, and beliefs without the risk of disapproval or rejection by the therapist (Mearns and Thorne, 2000). The practice of UPR aligns with humanistic therapy’s belief that we are fundamentally OK and there is no need to fix a person (House, Kalisch and Maidman, 2018). It doesn’t mean a nurturing therapist won’t challenge you, but they generally create a safe container for the therapeutic relationship to develop, supporting your exploration and growth.
In the other camp, the challenging therapists come from the lineage of the psychiatrist Fritz Perls, one of the founders of Gestalt therapy (Perls, Hefferline and Goodman, 1994). He used a confrontational approach with clients (Perls and Wysong, 1992).
The Gestalt approach focuses on the client’s present moment experience, relationships, and environment (Joyce and Sills, 2014). It supports the idea of personal responsibility and experimenting with adjustments they can make in response to their situation (House, Kalisch and Maidman, 2018). The self is a process of being in contact with the world (Clarkson and Cavicchia, 2014).
The challenging therapist may use techniques to help you feel or acknowledge hidden aspects of yourself and make them known (Ginger, 2019). This process can be a journey of discovery and experimentation (Mann, 2010).
During a therapy session, a Gestalt therapist may support you in raising your awareness—including what you think and feel, how you behave, what is going on in your body, and sensory information. They may support you in exploring how you make contact with your environment and the people around you, including considering your impact on your environment and how it impacts you (Joyce and Sills, 2014).
There are various criticisms and discussions of the limitations of humanistic therapy. For example, some believe it is necessary for Gestalt therapists to possess a high level of personal growth and must be learned through practice, not by reading or writing about its principles (Orfanos, 2021). Others worry about the limits of person-centred therapy because each therapist offers their genuineness, making each therapist’s approach unique (Mearns and Thorne, 2013).
You might be getting the idea that finding an issue or weakness with every type of therapy is possible, and that is true. When therapy isn’t effective, it can sometimes be down to the therapist not using the most helpful technique or modality at the right moment for the client (Cooper, 2019). For example, timing a solution-focused intervention that requires action when a client needs more self-understanding and reflection may not be helpful. At the same time, timing the same intervention when the client is ready to take action but isn’t sure of the next step might work better.
When the client knows enough about how a therapist works, and the therapist knows enough about the client as a person, it becomes easier to use the right approach at the right time (Cooper, 2005).
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About Psychodynamic Therapy
Psychodynamic therapy emphasises relationships and development throughout one’s lifetime (Jacobs, 2017). It accepts that life is challenging and believes that humans are in tension with themselves, their environments and the people around them (Leiper and Maltby, 2004). The therapeutic process includes exploring and understanding these challenges and tensions to support change and alleviate some suffering (Howard, 2017).
Psychodynamic theory grew out of the psychoanalytic theory of Sigmund Freud (Leiper and Maltby, 2004). His ideas were radical at the time and created the foundation for multiple waves of theorists to continue to refine and develop new ideas about human development and relationships (Jacobs, 2017; Leiper and Maltby, 2004).
A psychodynamic therapist may support you in exploring your childhood development and relationships with your parents or primary caregivers (Howard, 2017). With your therapist, you might look at significant relationships throughout your life through the lens of attachment theory, which considers psychological security in relationships with others starting from infancy (Holmes, 2001). You might also explore other significant experiences or relationships from childhood through adolescence to the present day (Storr, 2012).
While CBT focuses on conscious thoughts, feelings, and behaviours (Fenn and Byrne, 2013), psychodynamic theory looks at aspects of the unconscious mind (Leiper and Maltby, 2004). You might look at things below the surface and connect with your inner guidance system (Bargh and Morsella, 2008). A psychodynamic therapist will use techniques to explore your unconscious and bring these deeper thoughts, feelings, and behaviours into your conscious awareness so they can be explored and understood (Howard, 2017).
During a session, you might do something called free association, where you talk about whatever comes to mind without censoring yourself (Howard, 2017). You might feel like you are talking endlessly about unrelated things. But after a while, with the therapist’s help, you can make connections and see patterns contributing to challenging aspects of your life.
You might explore dreams in pursuit of messages from your unconscious or to unblock your flow of thoughts (Storr, 2012). Similar to some forms of humanistic therapy, including Gestalt (Joyce and Sills, 2014), psychodynamic therapy can feel like a creative process of self-understanding (Leiper and Maltby, 2004).
Psychodynamic therapy considers the relationship between the client and the therapist in a subtle and significant way. They work with a phenomenon called transference, where you project the experience of previous relationships onto the therapeutic relationship to understand the past relationships (Sohtorik İlkmen and Halfon, 2019). Sometimes, just as you dislike people in your day-to-day life, you might dislike your therapist. And the same goes for love, so watch out. Transference can appear in any therapeutic relationship (BPS), and it can be helpful in other modalities to understand your implicit or unconscious goals (Cooper and Mcleod, 2011).
While CBT therapy is directive (Fenn and Byrne, 2013), and humanistic therapy is generally non-directive (Elliott et al., 2021), psychodynamic therapy contains aspects of each approach (Jacobs, 2017). The therapist looks to the client to choose what to talk about, and the therapist will listen to draw out certain aspects related to essential concepts within the psychodynamic theory, including understanding your motivations and listening out for what you might have difficulty expressing or sharing (Frederickson, 2013).
Because of psychodynamic therapy’s techniques and their mix of directive and non-directive qualities, you may experience multiple sessions in a row where nothing seems to be happening, like you have entered a vast desert. After wandering without much seeming to happen, you might enter a period of deep self-understanding and change.
Many of psychodynamic therapy’s criticisms are of Freud and his psychoanalytic theories, which are worthy of debate (Holowchak, 2012). Other criticisms of psychodynamic therapy draw attention to the lack of scientific evidence for the efficacy of psychodynamic psychotherapy using randomised controlled trials (Fonagy, 2015). However, other studies have also shown it is effective (Shedler, 2010; Steinert et al., 2017).
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Considering Integrative Psychotherapy
Now that I have gone through the three options you provided, I want to offer one more to consider. If you like the idea of working with a therapist who uses multiple modalities, you can put these three aside and look for an integrative therapist. Instead of focusing on one modality, an integrative therapist uses a combination of modalities (Zarbo et al., 2016).
You can search online to find an Integrative Therapist. If you want to work with me, you can learn more about how I can help and book your consultation here.
Making your choice
In closing, I have shared a few things to consider when choosing a therapist.
An important factor is your sense of being comfortable with the therapist. This supports the possibility of achieving relational depth, a sense of connection between you and the therapist (Cooper, 2017).
The therapist’s responsibility is to create an environment to nurture the common factors and core conditions. Still, it will be your responsibility to engage with therapy and the therapist so they can develop. It may benefit you to be open to receiving empathy, building a relationship with the therapist, setting goals, collaborating, and staying open to your emotional experience (Nahum, Alfonso and Sönmez, 2018).
Additionally, although the modality you choose may statistically factor less than other elements, it still plays an important and meaningful role. It will provide the philosophical underpinnings for your exploration and change.
Your belief that your chosen approach has value may change your expectations for therapy. Higher expectations may lead to a better outcome for you (Greenberg, Constantino and Bruce, 2006).
Hopefully, this post has given you some helpful information so you can make a choice that feels right for you.
Ready to begin?
Image by Matthias Cooper
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