Psychotherapies

Last updated 3/217/2025

Psychotherapy — is almost certainly not what you think it is!

Types of therapy

If you ask a therapist what technique or methods they use, here are the most likely answers:

Therapy	Focus
Cognitive Behavioral Therapy (CBT)	How thoughts affect mood
Supportive Therapy or counseling	Good listening, and empathy for you
Mindfulness Training	Accepting thoughts and feelings
Psychodynamic psychotherapy	Unconscious thoughts and feelings
Behavioral Activation Therapy (BAT)	Focus on getting in action
Problem-Solving Therapy	… step by step, with help…
Interpersonal	Relationships

Many therapists will say they use several of these; they are “eclectic”. But sometimes “eclectic” can mean a therapist is not well-trained in specific methods. This is particularly likely for counselors offering supportive therapy, which can still be helpful, and some counselors are really good at it.

But the bottom line is: different therapies are like different medications. One may work when another didn’t. If you’re not getting results after 4-6 sessions, talk to your therapist about maybe a different approach. Or a different therapist. Except for psychodynamic therapy…

Psychodynamic therapy is the modern version of Freudian “psychoanalysis”. You know, with the couch, and the therapist who only says “uh huh” once in a while or “tell me about your mother”. Those stereotypes still show up (like in New Yorker cartoons) because there’s just a little truth in them. But dynamic psychotherapy is actually very good — for helping you look at things you don’t want to look at. Kind of like going to college to study… yourself. But it can seem like it’s “not working” if you’re not clear on what you’re doing there.

Sometimes any therapy will do

Depressions can make themselves worse, a “downward spiral” effect, where you feel bad so you do less of the things that make you feel good, so you feel worse, and so on.

Sometimes you just have to reverse the spiral. Feel a little better, do a little more of the things that make you feel good, feel a little better, and so on. That’s why simple self-change steps, even though they seem small, can be enough sometimes. They end up having an effect much bigger than the small change you made.

Psychotherapies can do the same thing. They can simply help you take some of those small self-change steps: a little more contact with people, a little more attention to what you’re eating. It might just be seeing yourself make take positive steps, not the steps themselves, that gets the spiral going back up.

Psychotherapy is not necessarily long or expensive, either. There are low-cost (like $30), easy-to-find alternatives to seeing an individual psychotherapist. Here’s a summary of those options.

The point is, sometimes it doesn’t matter exactly what kind of therapy you get. But let’s look at why you might seek a particular kind of therapy for a particular kind of depression, if you have choices. Then to wrap up, I’ll offer my interpretation of how therapy works.

Which therapy, for which kind of depression?

You may have already read the page about the 4 main kinds of depression. If not, the following will make more sense if you go there first.

Single episode

You were doing fine, now you’re depressed. Obviously the goal is to get back to where you were before. Or maybe better, if the “before” wasn’t so great; if so, also read about Lifelong depression below.

While any therapy might help, as described above, probably the most basic (and cheap and widely available) is CBT, Cognitive Behavioral Therapy. Cheap because it is generally given in 6 to 12 sessions. Period. This doesn’t go on for many months, or years, as some therapies tend to do.

A high-quality do-it-yourself version of CBT is available on the internet for about $30, one time fee. Several research studies have found this version almost as good as seeing a live therapist, especially if you’re motivated enough to get through the program on your own. It’s from Australia’s National Health Service, called MoodGym. But only about 10% of people who start it, finish it. For the less internally motivated, a program that prods you to continue has shown good results too: Rejoyn, currently $50, soon to be $200 but insurance may cover some or all of that. You need a prescription, minor hassle.

Lifelong depression

Two approaches: either just try to raise your mood slightly, maybe more and more over time; or, dig deeper and go after the root causes.

For raising your mood level a bit at a time, all the self-change strategies are worth considering, maybe trying before hiring a therapist. Because you see, once you start this slow process, it could go on for quite a while, so could become expensive. But the main therapies could all help: CBT, Behavioral Activation (BAT), and Interpersonal.

Watch out for supportive therapy. It could definitely help, by making your mood and the stresses you now face, and probably some awful history, a bit more tolerable. You’d not be alone with these things. Yes, that would be good. And… supportive therapy doesn’t try to change those things, it helps you live with them.

So supportive therapy has no natural end-point. It can go on for months, years. And then, when you try to stop, there’s almost certainly going to be some “withdrawal” unless you’ve improved a lot and have filled your life with people and activities and responsibilities that will replace your supportive therapist. Think about that before you start.

Episodic Depressions

For this kind of depression, therapy might need to be more specific. But again, CBT and Interpersonal can help nearly anybody with nearly any mood issue. Starting there would be fine. And… if your episodic depressions turn out to be more like “bipolar” mood shifts — see “Mood swings without mania” — then there’s one more therapy to consider, the one that stabilizes mood and can prevent the next depression (as well as help you get out of this one).

That’s Social Rhythm Therapy, or it’s much simpler version that focuses on regular sleep timing.

Mixed Depressions

Mixed depressions are like plain depression with a high-energy part as well: usually anxiety, anger, agitation, and attention problems (the 4 A’s). Treating the depression without treating the high-energy part can make the depression treatments ineffective. They might work, once the high-energy part is better controlled. How do you do that?

Two choices: if you’re not suffering too much, so you can take some time to see if this works, then you could start with Social Rhythm Therapy or it’s simpler version that focuses on regular sleep timing. But if your mixed depression is really bad right now, that’s when turning to a medication approach early makes sense (pills, but not antidepressants; instead, mood stabilizers with antidepressant effects.)

Common ingredients in effective therapies

Research suggests that technique (CBT, interpersonal, psychodynamic) is not what matters. Instead, it’s the following ingredients:

• Someone you trust, in a safe space
• who, with your full agreement about what the problem is
• helps you recognize what you’re avoiding
• and encourages you to “avoid avoidance”
• which leads you to “exposure”: experiencing the thing you were avoiding
• and discovering that it wasn’t so bad after all.