Psychotherapy

From the talking cure to many schools

A 2024 narrative survey of psychotherapy, which its authors call brief and selective and whose authors disclose commercial interests, describes pre-Freudian treatment as symptom-focused and Freud as offering a theory built on early experience, unconscious processes and inner conflict, together with a talking method. The same survey places behavioral therapies, cognitive therapies and family and social systems therapies in the period 1950 to 1970.

The UK Council for Psychotherapy (UKCP) describes psychoanalytic practice as resting on the belief that unconscious processes and early life experiences shape later relationships. It lists Freudian, Jungian, object relations, attachment-based, relational and psychodynamic strands within that tradition.

Humanistic, existential and systemic strands

UKCP describes humanistic and integrative psychotherapy as an umbrella for approaches that developed over more than seventy years, including person-centered, Gestalt and transactional analysis. A 2023 review names Kierkegaard and Nietzsche as forerunners of existentialism, places Frankl's logotherapy in the Second World War era, and cites Yalom's 1980 Existential Psychotherapy. A 2019 study credits Minuchin with originating structural family therapy and cites his 1974 book.

Behavioral, cognitive and third-wave labels

A 2017 editorial describes a first wave of behavior therapy, a second wave of classic cognitive behavioral therapy (CBT) focused on maladaptive thinking by the late 1970s, and a third wave declared in 2004. It names acceptance and commitment therapy, dialectical behavior therapy and mindfulness-based cognitive therapy as third-wave approaches. The authors note that the label was controversial. A 2012 review names Ellis (1962) and Beck (1970) as pioneers of CBT.

Expressive, body-oriented and trauma-focused members

Reviewed sources date psychodrama to Moreno in 1921 and Hakomi to Ron Kurtz, whose first training was in 1977, with the Hakomi Institute founded in 1981. Ego state therapy is described as evolving from a psychodynamic view of personality as a set of ego states, and Internal Family Systems is credited to Richard Schwartz, whose 1995 book a later study cites. These accounts come from proponents or secondary sources.

Psychotherapy, counselling and psychotherapeutic counselling

Usage differs by body. UKCP distinguishes psychotherapists, who train to postgraduate level, from psychotherapeutic counsellors, who train to a recognized standard that is normally graduate level or equivalent. The English guideline on adult depression uses counselling for a specific protocol with a focus on emotional processing, so the same word can name a profession or a defined treatment.

Psychoanalytic and psychodynamic

UKCP lists psychodynamic psychotherapy within psychoanalytic practice. A 2023 umbrella review defines psychodynamic psychotherapy as a family of approaches focused on recurring relational patterns, emotion, defenses and the influence of past experience, working along a supportive-interpretive continuum. The English guideline uses the narrower label short-term psychodynamic psychotherapy for a protocol developed for depression.

Families of therapies with shared names

The British Association for Behavioural and Cognitive Psychotherapies describes CBT as a family of talking therapies, and the 2017 editorial proposes process-based therapy as an umbrella that might eventually reduce the importance of the CBT label. UKCP notes that family therapy and systemic psychotherapy are often used interchangeably. Similar names do not show that practices are equivalent.

Formats and settings

UKCP describes individual, couples, family and group formats, with sessions that can also be held online or by phone. Psychoanalytic work may involve a couch or a chair and attendance from once a week to twice or more a week. In the English depression guideline, individual protocols typically run 8 to 16 sessions, and CBT for more severe depression usually 16 sessions.

What differs between approaches

Psychoanalytic work may use free association and dream material. Person-centered work is described as offering an accepting relationship with empathic understanding. CBT is described in the English guideline as structured, goal-oriented and usually involving homework. Systemic work focuses on interactions among family members, and expressive therapies such as art, dance and drama therapy combine talking with the arts or movement.

Participants may find some work uncomfortable. The English guideline notes that focusing on painful experiences in close relationships could initially be distressing in short-term psychodynamic psychotherapy, and that interpersonal therapy requires a willingness to examine relationships. This page does not give step-by-step instructions for any technique.

Reasons people seek therapy

UKCP states that psychotherapists and psychotherapeutic counsellors support people with depression, anxiety, addiction and trauma, and with life events such as bereavement, divorce or job loss. These are the organization's descriptions of the uses. They are not outcomes it has tested.

Uses described for particular approaches

Organizations describe psychoanalytic therapy as sought for depression, anxiety and longer-standing difficulties, play therapy as used for children with low confidence, anger or fear, and EMDR as a way of reprocessing distressing memories. The English depression guideline states that interpersonal therapy may help when depression is linked to relationship transitions or loss, and behavioral activation when depression has led to withdrawal.

Claims the reviewed sources do not test

UKCP describes systemic therapy as particularly effective for problems between a child and an adult. The family therapy source reviewed here is a small uncontrolled study, so it does not test that statement. Claims that one school suits everyone, or that a specific school is superior, should be read against the comparative findings in the evidence sections.

Adult depression across approaches

A 2021 network meta-analysis of 331 randomized trials with 34,285 adults compared eight psychotherapy types for depression. All outperformed care as usual and waiting list, and all except non-directive supportive counseling and psychodynamic therapy outperformed pill placebo. Apart from supportive counseling, which did less well, therapies did not differ significantly. Certainty was mostly low to very low, and only 90 trials reported 12-month outcomes.

Guideline-level recommendations

The 2022 English guideline on adult depression lists guided self-help, group mindfulness, interpersonal therapy, counselling and short-term psychodynamic psychotherapy for less severe depression, and CBT, behavioral activation, problem-solving, counselling, psychodynamic psychotherapy and interpersonal therapy for more severe depression. The 2018 English guideline on post-traumatic stress disorder (PTSD) lists trauma-focused CBT and EMDR, and advises against psychologically focused debriefing. Both are condition-specific. The American Psychological Association and World Health Organization guideline pages could not be opened and are not covered.

Common factors and equivalence

A 2015 review reports that the alliance correlates with outcome across nearly 200 studies (d = 0.57), that differences among treatment types are at most about d = 0.20, and that dismantling studies show d = 0.01 for removing an ingredient. The author calls most of this evidence correlational and the contextual model one of several. A 2023 umbrella review rated psychodynamic therapy as equivalent to other active therapies for depression, anxiety, personality and somatic symptom disorders, with moderate certainty in most comparisons.

Cognitive behavioral and borderline personality disorder

A 2012 review of 106 sampled meta-analyses (from 269) found the strongest support for CBT in anxiety disorders, somatoform disorders, bulimia, anger control and general stress, with mixed findings for depression and limited findings for several other groups. A 2020 Cochrane review of 75 trials (4,507 participants) found borderline personality disorder severity lower with psychotherapy than with usual care (SMD -0.52). Subgroups showed no clear difference between types, and adverse effects were unclear.

Expressive, body-oriented and smaller approaches

A 2019 review of 31 psychodrama publications included 11 randomized comparisons and noted methodological weaknesses. A 2015 Cochrane review of dance movement therapy for depression found three small trials (147 participants) and no firm conclusions. A 2005 meta-analysis of play therapy with children pooled 93 studies, and only its abstract was read. Internal Family Systems has one randomized trial in rheumatoid arthritis (79 people), and a sensorimotor-based group had a 32-person pilot trial.

The sources reviewed offer no controlled trial of Hakomi, and the ego state therapy paper reviewed examines research status in general terms without reporting trial results. Findings for one member should not be applied to another.

Documented negative effects

A 2014 paper defines unwanted events and side effects of psychotherapy and states that precise rates cannot yet be given, with about 5 to 20 percent as an emerging consensus range. A 2023 systematic review of 85 randomized trials (14,420 participants) concluded that adverse events can be expected to affect more than one in ten participants and serious ones more than one in 21, and that harm reporting was inconsistent and often unclear in its link to treatment.

The 2014 paper also notes that therapy can lead to convincing false memories, with unknown frequency. The 2023 umbrella review reported few adverse events in psychodynamic trials but poor reporting. Not reporting harm is not evidence that none occurs.

Suitability and care boundaries

The English depression guideline lists conditions under which approaches may be less suitable, for example intense distressing thoughts in mindfulness-based cognitive therapy. Psychotherapy information on this page is educational. It is not a substitute for assessment or for necessary medical or crisis care, and anyone at risk of harm should contact emergency or crisis services.

Training, registers and codes

UKCP states that its voluntary register is accredited by the Professional Standards Authority, and that registration typically follows three to six years of part-time training with about 450 hours of supervised practice. The British Association for Counselling and Psychotherapy requires members to work within its Ethical Framework, adopted in 2018, with a 2026 version mandatory from 3 November 2026. The British Association for Behavioural and Cognitive Psychotherapies accredits CBT practitioners. Requirements outside these bodies and countries were not reviewed.