Psychotherapies: CBT, psychodynamic, DBT and family therapy

• Psychotherapy is a structured, evidence-based, collaborative talking treatment built on a therapeutic alliance, shared goals, and regular review; it is the recommended first-line or core treatment for many common mental health conditions, on its own or with medication.^[1][4]
• Cognitive behavioural therapy (CBT) is goal-oriented and present-focused; it treats the interaction between thoughts, feelings, and behaviour, using techniques such as thought records, behavioural activation, and exposure, usually in 6 to 20 weekly sessions.^[2]
• Psychodynamic psychotherapy uses the therapeutic relationship to explore patterns rooted in early experience and relationships; short-term work typically targets one pressing problem over about 16 sessions.^[1]
• Dialectical behaviour therapy (DBT) is a specialised form of CBT for borderline personality disorder (BPD) and repeated self-harm, targeting emotion regulation, distress tolerance, and interpersonal skills; meta-analytic evidence supports a medium reduction in suicidal and self-injurious behaviour.^[5]
• Family and systemic therapy changes the interaction patterns around a person in their family or social system; 10 to 25 sessions are often enough, and it is one of the treatments recognised for affective, anxiety, eating, substance-use and psychotic disorders, as well as for children and adolescents.^[6]
• Motivational interviewing (MI) is a brief, autonomy-supporting counselling style that strengthens a person's own motivation to change; 1 to 4 sessions of about an hour are typical.^[8]
• Stepped care starts with the least intrusive, most resource-efficient effective option and steps up or across on review, which is how services such as Improving Access to Psychological Therapies (IAPT) organise treatment.^[1]

By the end of this page you should be able to:

1. Explain how the main evidence-based psychotherapies differ in theory, focus, and length.
2. Carry out a brief CBT-style formulation and choose appropriate CBT techniques, including exposure, for a specific problem.
3. Describe when psychodynamic, DBT, and family or systemic therapy are indicated, and what the evidence does and does not show.
4. Use motivational interviewing (MI) style and basic MI skills, and state the evidence for MI in substance use.
5. Plan treatment within a stepped-care pathway and know the usual session numbers and review points.
6. Recognise contraindications, risks, and adverse effects of psychotherapy, and know when urgent specialist referral is needed.
7. Deliver care consistent with NICE, APA, and WHO mhGAP guidance and with good therapist practice (manuals, supervision, outcome monitoring).

Psychotherapy is not one single method. Loosely, it ranges from highly structured, symptom-focused treatments (CBT, exposure therapy, DBT skills) to more exploratory ones (psychodynamic, systemic). What unites effective practice is not the label but the active ingredients: a working alliance, a clear and shared formulation, credible techniques delivered with competence, enough dose, and routine outcome review.^[1][2]

This page treats psychotherapy as a procedure: assessment, treatment selection, delivery, monitoring, and ending, with clear safety checks at each stage. That clinical framing is useful even for therapies that feel exploratory.

Why it matters. Mental, neurological and substance-use conditions are common, and most people who need care do not receive it; the WHO estimates that over 75% of people with these conditions cannot access treatment or care.^[3] Psychotherapy is the core or recommended treatment for many of them, and in low-resource settings the mhGAP model trains non-specialists to deliver it.^[3][4]

Common principles of good practice.

• Build a trusting relationship, ensure the person can see the same clinician where possible, and record their views and preferences.^[1]
• Match treatment to clinical need, severity and preference; use the least intrusive and most resource-efficient effective option first.^[1]
• Base treatment on an agreed manual; use competence frameworks and regular supervision, with competence monitored and evaluated (for example, supervisor review of recordings, with consent).^[1]
• Monitor regularly with validated sessional measures (for example the PHQ-9 for depression) and review how treatment is working within 2 to 4 weeks.^[1]
• Agree a management plan, and review benefits and harms; advise people of any waiting lists and stay in contact while they wait.^[1]
• Attend to diversity and culture: adapt language, format (individual, group, remote), and content, and ensure access and equality of outcomes.^[1]

CBT is a structured, present-focused treatment typically delivered in 6 to 20 weekly sessions^[2]. It rests on Beck's cognitive model: situations trigger automatic thoughts based on deeper beliefs (schemas) about the self, the world and the future; these thoughts produce emotions and behaviours that then feed back. Avoidance and withdrawal are negatively reinforced and keep symptoms alive. The therapist and patient collaborate to test and change these maintaining factors.

The APA lists CBT among the psychotherapies recommended for depression in adults, and NICE recommends guided self-help, group or individual CBT among first-line options for less severe depression, with individual CBT usually comprising 8 sessions, and (for more severe depression) 16 sessions, with additional sessions for comorbidity or complex social needs.^[2][1]

Core techniques (names and purposes are standard, and the examples reflect the APA depression guideline's description of CBT) include:

• Psychoeducation about the links between thoughts, feelings and behaviour, so that the patient sees symptoms as understandable and changeable.^[2]
• Self-monitoring with a mood diary recording situations, automatic thoughts, emotions and behaviour.^[2]
• Cognitive restructuring: identifying unhelpful thoughts (all-or-nothing thinking, catastrophising, mind-reading), examining evidence for and against, and generating more balanced alternatives using Socratic questioning.^[2][7]
• Thought records completed as homework, which consolidate skill and test beliefs in daily life.^[2]
• Behavioural activation: identifying reduced or avoided activities, planning graded re-engagement with pleasurable and valued activities, and reversing withdrawal.^[2] NICE describes behavioural activation (BA) as identifying the link between activities and mood and planning practical changes that reduce avoidance.^[1]
• Behavioural experiments: directly testing a fear or belief (for example, asking a boss whether a comment was meant as criticism) rather than arguing about it.^[2]
• Graded exposure to avoided situations, described below.
• Problem-solving, often 6 to 12 sessions, focusing on defining problems, generating and testing solutions.^[1]
• Relapse prevention: planning how to recognise and respond to early warning signs after therapy ends.^[1]
• Homework between sessions, which the APA notes is essential for developing new skills and confidence.^[2]

Two quantitative reference points help set expectations: adults with depression receive on average 6 to 20 weekly sessions of CBT, 8 to 28 of cognitive therapy, or 20 to 24 of behavioural therapy, and MBCT is usually 8 weekly two-hour group sessions with a retreat and booster sessions.^[2]

Exposure is a central CBT method for anxiety disorders and is one of the best-established psychological treatments. It is based on emotional processing theory (Foa and Kozak, 1986, as summarised in PMC4610618): fear is held in associative networks that are activated by safe but feared cues; avoidance prevents new learning; deliberately confronting the cue while recording the absence of harm allows the fear structure to be corrected.

Forms of exposure^[7]:

• In vivo exposure: graded, real-life approach to safe places, objects, people or situations previously avoided.
• Imaginal exposure: vividly imagining the feared situation or consequence without avoiding the anxiety.
• Interoceptive exposure: deliberately inducing feared bodily sensations (for example running to raise the heart rate), mainly for panic disorder.
• Prolonged exposure for PTSD: repeated imaginal revisiting of the trauma memory, processing it in session, recording the narrative for between-session listening, plus in vivo homework to avoided safe cues.
• Exposure and response prevention (ERP) for OCD: in vivo and imaginal exposure to feared cues without performing the compulsive ritual, combined in vivo and imaginal being more effective than in vivo alone in meta-analytic comparison.

Exposure is considered the treatment of choice for many forms of pathological anxiety, including specific phobias (where in vivo exposure is highly effective, and adding cognitive techniques does not add benefit over exposure alone), OCD and PTSD.^[7] For social anxiety the in vivo exposure targets safety behaviours; for generalised anxiety disorder imaginal exposure to worst-case scenarios is used. In general exposure therapy is time-limited and is typically completed in about 10 sessions.^[7]

A practical point from the evidence: adding formal cognitive restructuring to prolonged exposure has not been shown to improve PTSD outcomes, whereas adding exposure to cognitive therapy does enhance outcome.^[7] This supports doing exposure properly rather than replacing it with discussion.

• Depression: recommended by both NICE (guided self-help, group/individual CBT, behavioural activation) and the APA (CBT recommended for adults).^[1][2]
• Anxiety disorders: WHO mhGAP (third edition, 2023) recommends offering CBT-based psychological interventions for adults with generalised anxiety disorder and/or panic disorder, in online, in-person, group or self-guided formats.^[3]
• Exposure-based treatments show good outcomes in meta-analytic comparisons with no-treatment and placebo control conditions across anxiety disorders.^[7]
• WHO mhGAP (third edition) recommends structured psychological interventions for moderate-to-severe depression, namely behavioural activation, brief psychodynamic therapy, CBT, interpersonal therapy (IPT), problem-solving therapy and third-wave approaches, with a strong recommendation and moderate certainty of evidence.^[4]

Psychodynamic therapy works from the premise that current symptoms and relationship difficulties are fuelled by partly unconscious mental processes, often organised around early experiences of loss, attachment and separation. The therapist offers a reliable, reflective relationship in which repeating patterns can be recognised, tolerated and revised. Variants are based on drive or conflict, interpersonal or relational, or attachment theories; treatment may be short- or long-term depending on the person's preference and need.^[2]

Standard technical elements include exploring current mood and thinking, recognising characteristic verbal and non-verbal patterns, working with transference reactions in the therapeutic relationship, and relating insight to change in everyday relationships.^[2] Patients are often helped to tolerate difficult feelings rather than act on them, and to distinguish past conflicts from present situations.^[2]

• Adults generally receive 3 to 80 weekly sessions of psychodynamic therapy, although the APA panel reviewed short-term psychodynamic therapies.^[2]
• NICE specifies short-term psychodynamic psychotherapy (STPP) as 16 regular sessions for depression, with more if needed, using an empirically validated protocol developed for depression: focus on recognising difficult feelings in significant relationships and stress, identifying repeated patterns, with attention to the therapeutic relationship as a working-through aid.^[1]
• Ending therapy is handled carefully, because people whose core theme is loss may re-experience it as they say goodbye.^[2]

NICE includes STPP and IPT among the options for a new episode of more severe (moderate to severe) depression, and the APA recommends psychodynamic therapy (along with behavioural, cognitive, CBT/mindfulness-based cognitive therapy, IPT and supportive therapy) for initial treatment of depression in adults.^[1][2] WHO mhGAP (third edition) also lists brief psychodynamic therapy among the structured psychological interventions to be offered for moderate-to-severe depression.^[4]

NICE's treatment table suggests STPP may be useful for people whose emotional and developmental difficulties in relationships contribute to their depression, but that it may be less suitable for people who do not want to focus on their own feelings, or who do not wish or feel ready to discuss close or family relationships, and that focusing on painful experiences could initially be distressing.^[1]

DBT was developed by Marsha Linehan for chronically suicidal individuals and evolved into a comprehensive cognitive-behavioural treatment for BPD. Its theory is that people with BPD often lack the capacity to regulate emotion or tolerate distress, and that personal and environmental factors block the use of skills they do have.^[5] Treatment is built on a dialectical stance combining acceptance (validation) with change, and on explicit hierarchical targets^[5]:

1. Decrease life-threatening suicidal and self-injurious acts.
2. Decrease therapy-interfering behaviour (lateness, non-attendance, excessive between-session contact).
3. Decrease quality-of-life-interfering behaviour (including depression and substance use).
4. Increase behavioural skills (emotion regulation, mindfulness, distress tolerance, interpersonal effectiveness).

In routine practice this means a package: individual therapy, skills-training groups, between-session coaching, and a therapist consultation team. Comprehensive DBT requires substantial training and fidelity monitoring.

BPD has an estimated general population prevalence of 0.3 to 3.0%, rising to 7% in primary care and up to 50% in inpatient psychiatric settings, and roughly 70 to 80% of people with BPD engage in self-destructive behaviour.^[5] APA BPD practice guidance identifies psychotherapy as the core treatment and DBT specifically as having persuasive data from randomised controlled trials.^[5]

A meta-analysis of five RCTs (247 participants) found^[5]:

• A net benefit favouring DBT over treatment as usual for suicidal and parasuicidal behaviour, pooled Hedges' g of -0.622 (medium effect); DBT reduced suicide attempts by approximately two thirds. ^[5]
• Only a marginal advantage for DBT in reducing attrition, pooled risk difference -0.168. ^[5]
• No statistically significant advantage for DBT in reducing depression, despite a large pooled effect, because of heterogeneity across studies.
• DBT was not uniformly better across the four targets; skills acquisition was the least consistently supported.

The message for practice: refer or offer DBT when the dominant problem is repeated self-harm or suicidal behaviour in suspected or diagnosed BPD, and be honest with patients that the evidence is strongest for stabilising self-destructive behaviour, not for mood alone.

• Indicated (or strongly considered): BPD with recurrent suicidal or parasuicidal behaviour, marked emotion dysregulation, and therapy-interfering behaviour.
• Consider when there is high utilisation of crisis and emergency services.
• Less evidence-supported as stand-alone treatment for major depressive disorder (see pooled depression result above).
• Requires the patient's willingness to attend, learn skills and complete diary cards; chaotic engagement is expected and is itself a treatment target, but assessment of risk and safety planning come first.

Systemic therapy is a psychotherapeutic method focusing on the social context of mental disorders: the interactions between symptoms and family or social systems, reciprocal and self-reinforcing patterns, boundaries, communication and resources.^[6] Rather than treating the individual in isolation, it works on the patterns that maintain difficulties and on mobilising existing family strengths.

Core techniques include systemic, circular and solution-focused questions, positive reframing, genograms (family trees spanning three or more generations), family sculpting, tasks and prescriptions, and multi-person sessions, with attention to neutrality and respect for all involved, including absent members.^[6]

Sessions are often held at intervals of 1 to 6 weeks, and 10 to 25 sessions are often sufficient, although there may be many more (in Germany the maximum reimbursable amount is currently 48 therapy units of 50 minutes individually or 100 minutes in group). Video feedback, team reflection (with breaks) and supervision are useful supports.^{[6] [8]}

A 2024 review of seven meta-analyses reports evidence of benefit for systemic therapy in adults for affective, anxiety and obsessive-compulsive, substance-use, eating and schizophrenia/psychotic disorders; for children and adolescents for anxiety and obsessive-compulsive, attention-deficit/hyperactivity, eating, substance-use and mixed disorders.^[6] Specifically, for depression in adults, systemic therapy was superior to no add-on treatment, with Hedges' g 1.09 (95% CI 0.78 to 1.40) at post-test and 1.23 (0.80 to 1.68) at follow-up, and it did not differ significantly from other psychotherapies; in children the evidence is more mixed and some studies favour CBT.^[6]

German regulatory bodies recognised systemic therapy for adult psychotherapy with documented efficacy in five areas (affective, anxiety/OCD, substance-use, eating, and psychotic disorders), and for children and adolescents in five (anxiety/OCD, hyperkinetic, eating, substance-use, and mixed disorders). In personality disorders, no difference in efficacy between systemic therapy and other guideline-based psychotherapies was found.^[6]

Systemic therapy in a multi-person setting is indicated when the difficulty affects more than one person, when the person or significant others request it, when the person is heavily dependent on others (especially a child or adolescent), when family interactions clearly influence the course of illness, or when family resources need activation.^[6] For children and adolescents, involving the parents is essential, although joint physical presence in the room is not always required.^[6]

Contraindications to multi-person work include rejection of family or couples sessions by the person or family, and any significant risk of violent escalation, verbal abuse or re-traumatisation.^[6] Family secrets, traumatic insights from multi-generational exploration, and the therapist appearing to take sides are recognised modality-specific risks.^[6]

MI is a collaborative, person-centred counselling style that strengthens motivation by evoking the person's own reasons for change rather than persuading or instructing. The therapist uses partnership, acceptance, compassion and evocation, and elicits "change talk" while "rolling with resistance". MI is often delivered in 1 to 4 sessions of roughly an hour, and up to 9 sessions in some studies.^[8]

A large Cochrane review (93 studies, 22,776 participants) of MI for substance-use reduction found^[8]:

• Compared with no intervention: a small-to-moderate effect post-intervention (standardised mean difference 0.48, 95% CI 0.07 to 0.89; 6 studies, 471 participants; low certainty), weaker at short-term follow-up (SMD 0.20, 19 studies), still small at medium-term follow-up (SMD 0.12, 16 studies) and no significant difference at long-term follow-up (9 studies). ^[8]
• Compared with treatment as usual: a very small negative effect post-intervention (SMD -0.14, 5 studies), very small benefit at medium-term follow-up (SMD 0.12, 9 studies), no difference at long-term follow-up. ^[8]
• Compared with assessment and feedback: no difference at short-term follow-up (7 studies), small benefit at medium-term (SMD 0.24, 6 studies) and long-term (SMD 0.24, 3 studies) follow-up. ^[8]
• Retention was slightly higher with MI (SMD 0.26, 2 studies), and there was no clear effect on readiness to change. ^[8]

Overall the reviewers conclude that MI may reduce substance use compared with no intervention for a short time, and makes little to no difference compared with regular treatment or another active intervention; the review authors and related Cochrane reviews also report no meaningful effect in some younger or smoking populations.^[8] Certainty ranges from moderate to very low, so sensible use is as part of a package of care, not a stand-alone fix.

The manual, the clinician and the relationship matter as much as the label. Good practice, supported by NICE guidance on depression, includes^[1]:

• Use treatment manuals to guide the form, duration and ending of interventions, and use competence frameworks derived from those manuals to support training, delivery and supervision.
• Provide regular clinical supervision and monitor and evaluate competence, which can include the supervisor's review of audio or video recordings with patient consent.
• Build a trusting relationship, facilitate continuity of care, see the same professional wherever possible, and record the person's views and preferences so they follow them.
• Use shared decision-making about treatment, delivery and location, matching treatment to the individual, including considering the gender of the clinician and the option of bringing a family member or friend.
• Engage in collaborative, empathic skills (active listening, validation, unconditional positive regard, flexibility) that all psychotherapies share.^[2]

Specific therapy skills map to methods: Socratic questioning, guided discovery and behavioural experiment design for CBT^[2][7]; handling transference and endings for psychodynamic work^[2]; validation, behavioural chain analysis and coaching for DBT^[5]; circular questioning and working with absence and secrets for systemic work^[6].

• NICE (NG222, 2022): for depression, do not routinely offer antidepressant medication as first-line for less severe depression; offer psychological options (guided self-help, group/individual CBT or BA, IPT, STPP, counselling) and step up on review.^[1]
• NICE: for choice, support, and delivery, use least intrusive first, shared decision-making, manuals, supervision, and outcome monitoring.^[1]
• APA (2019 CPG, adults): recommended psychotherapies for depression include behavioural, cognitive, CBT/mindfulness-based cognitive therapy, IPT, psychodynamic and supportive therapy, with CBT or IPT plus a second-generation antidepressant for combined treatment.^[2]
• WHO mhGAP (third edition, 2023): strong recommendation that structured psychological interventions be offered for moderate-to-severe depression (BAT, brief psychodynamic, CBT, IPT, problem-solving, third-wave therapies; moderate certainty); CBT-based interventions offered for GAD and/or panic disorder, including digitally delivered formats; digitally delivered interventions feature across multiple modules.^[3][4]
• WHO mhGAP is used in more than 100 countries and over 20 languages, supporting non-specialist workers and task-shifting in low-resource settings.^[3]
• NICE stepped care/matched care (NG222, 1.16.1): commissioners should consider stepped or matched care, with easy access, prompt assessment including severity and risk, coordination across primary and secondary care, clear entry criteria at all levels, multiple entry points including self-referral, and routine data collection on access, uptake and outcomes.^[1]

Psychotherapy has no anatomical site or equipment in the usual procedural sense. Indications are the clinical presentations where these treatments have good evidence (see above). More general contraindications and cautions include:

• Immediate, high suicide risk or risk to others: manage safety first and refer urgently to specialist mental health services.^[1]
• Severe psychosis or mania without concurrent pharmacological or specialist management; treat the acute illness first.
• Marked cognitive impairment (advanced dementia, acute confusional state) that prevents engagement; adaptations may still be possible in milder cases.
• Conditions where the evidence base for the chosen therapy is poor or where the therapy could be harmful (for example, direct questioning that risks re-traumatisation, or family sessions where violence or severe coercion are likely).^[6]
• People who actively choose not to engage: psychotherapy depends on voluntary collaboration; autonomy and the right to decline treatment must be respected.^[1]

• Take a full assessment (severity, risk, previous treatment, comorbidity, psychosocial context), and agree a written management plan and review schedule.^[1]
• Obtain informed consent including the rationale, format, expected benefits and possible harms, duration, alternatives, and what happens if therapy does not help; provide written information where appropriate.^[1]
• Discuss cultural factors, language needs and access, and check whether the person prefers individual, group, remote, in-person or paired care, and the gender of the clinician.^[1]
• Prepare for comorbidity: for example, assess for bipolar disorder or PTSD during assessment, treat depression first when accompanied by anxiety unless an anxiety disorder should be treated first per local guidance.^[1]
• Risk assessment is part of preparation: ask directly about suicidal ideation, and never withhold treatment solely because of suicide risk.^[1]

1. Assess and formulate. Build a shared understanding (formulation) linking predisposing, precipitating and maintaining factors; for CBT, thoughts, feelings, behaviour and avoidance; for systemic work, the family pattern.
2. Plan treatment. Select the method, modality (individual/group/family/remote) and dose; agree goals and outcome measures.^[1]
3. Begin. Provide psychoeducation, build the alliance, negotiate the therapeutic contract, and establish roles and between-session work.^[1][2]
4. Deliver the active phase. Use the method's specific techniques with fidelity to the manual, tailoring to the individual. Review early (2 to 4 weeks) and adjust, step up or step across if there is little progress.^[1]
5. Monitor outcomes at every session using validated measures, and feed results back; re-rate risk regularly.^[1]
6. Prepare for ending from early on: consolidation, practice, coping planning, and booster sessions if useful.^[1]
7. End and review. Summarise learning, agree maintenance and relapse plans, record outcomes, and arrange follow-up or stepped-up care if needed.^[1]

Key principles of the model: start with the least burdensome, most effective option (guided self-help where appropriate), review regularly with the therapist, and allow people to step up to higher intensity, step across to another treatment of the same intensity, or step down based on progress; people can also start on higher intensity when justified. Multiple entry points, including self-referral, and routine collection of access, uptake and outcome data are features of a good pathway.^[1] Guided self-help is usually 6 to 8 sessions, group or individual CBT or BA usually 8 sessions (up to 16 for more severe cases), and IPT or STPP 16 sessions.^[1]

• Discuss how to maintain benefits and wellness near the end of treatment, and provide relapse-prevention and early-warning plans.^[1]
• For depression, medication (if used) is generally continued at the same dose after remission, with prescriber review, and withdrawal done slowly and in stages if stopping is agreed.^[1] (Medication management is outside this page's scope.)
• Offer booster sessions for IPT or MBCT alumni and scheduled follow-up for high-risk cases; recurrence of mental-health episodes should be anticipated and planned for.
• Collect outcomes and access data as part of the pathway, so services can audit equity and improve.^[1]

• Deterioration or non-response: a significant minority of patients do not improve; early monitoring identifies this. Do not keep delivering an ineffective therapy without review.
• Rupture or dropout: therapeutic ruptures, shame, or feeling misunderstood can end treatment early. Supervision and repair are core skills.
• Initial worsening: exposure and trauma-focused work can temporarily increase distress; anticipate and pace carefully.
• Family and relational risks: systemic work can surface secrets and shift family power; risks include adverse effects on the family, and contraindications must be respected.^[6]
• Therapist drift and harm: unsupervised, un-manualised, or competence-poor practice can deliver "pseudo-therapy"; DBT meta-analysis shows that ignoring model fidelity can weaken results.^[5]
• Medication interactions not applicable; psychological therapy can interact with care pathways (for example, waiting-list delays) and can raise risk if assessment or monitoring is skipped.

• Children and adolescents: family and systemic therapy has evidence across several conditions, including eating, anxiety, hyperactivity and substance-use disorders; for depression in this group the evidence for systemic therapy is mixed, and care should be matched to the individual.^[6] DBT adaptations for adolescents exist in practice, but decisions should follow local guidance and specialist supervision.
• Low- and middle-income settings: mhGAP is designed for non-specialist health workers; its third edition is used in more than 100 countries and over 20 languages, supports multi-session or briefer digitally delivered options, and stresses combining psychological with community care and support for carers in psychosis or bipolar disorder.^[3]
• Cultural adaptation: the manual and examples should be adapted to local beliefs, idioms of distress, and family structures; WHO mhGAP is organised as priority conditions and overviews precisely to support such adaptation.^[3][4]
• Older adults: psychotherapy works in older age; dose and pacing may need adjustment, and local guidance should be followed.^[2]
• Neurodevelopmental disabilities: adapt delivery for communication and cognitive needs, as NICE advises.^[1]

• Psychotherapy is a skilled, manualised, supervised and outcome-monitored procedure, not just "talking".
• CBT (6 to 20 sessions) targets the thoughts-feelings-behaviour cycle with behavioural experiments, exposure and homework, and is recommended for depression and many anxiety disorders.^[1][2][3]
• Exposure is the first-line component for specific phobias, OCD and PTSD components; it is usually complete in about 10 sessions and needs repeated real-life confrontation, not just discussion.^[7]
• Psychodynamic work (about 16 to 80 sessions) suits people who want to explore emotion and relationship patterns; NICE values STPP for depression with relational difficulties, while noting limits.^[1][2]
• DBT is the evidenced core treatment for BPD with recurrent self-harm; it reduces suicidal and self-injurious behaviour (medium effect) and attrition (marginally), but not depression reliably.^[5]
• Systemic/family therapy works on social context; evidence supports several adult and child conditions, and multi-person sessions are contraindicated with violence risk or family refusal.^[6]
• Motivational interviewing is brief and autonomy-supporting; Cochrane found possible short-term reduction in substance use versus no treatment and little difference versus active treatments, with moderate to low certainty.^[8]
• Stepped (IAPT) care starts with the least intensive effective option (guided self-help 6 to 8 sessions, group CBT/BA 8 sessions) and steps up or across on review.^[1]
• Therapist skill (manuals, competence, supervision, alliance, cultural adaptation) and shared decision-making are as important as the therapy name.^[1][2]
• Clinically, safety comes first: risk assess, refer urgently when needed, and do not run therapy without monitoring or competent delivery.

• Depression in adults
• Anxiety disorders (generalised, panic, phobias, OCD, social anxiety, PTSD)
• Borderline personality disorder
• Psychosis and schizophrenia
• Eating disorders
• Alcohol and substance use
• Child and adolescent mental health
• Clinical formulation and therapeutic alliance