Types of talking therapy: CBT, DBT, EMDR and more
Talking therapies are structured treatments delivered by a trained therapist, not just a chat. The best-evidenced is cognitive behavioural therapy (CBT), recommended for depression, anxiety disorders, OCD and PTSD. EMDR and trauma-focused CBT are first-line for PTSD; dialectical behaviour therapy (DBT) is used for recurrent self-harm and borderline personality disorder; interpersonal and short-term psychodynamic therapy are options for depression; family therapy is first-line for anorexia in young people. Most courses run for 8 to 20 weekly sessions, while DBT usually lasts about a year.
Health writers · Aslam Clinic
Talking therapy is not simply talking. Each recognised therapy has a theory of what keeps a problem going, a set of techniques to change it, and research showing whether it works. Cognitive behavioural therapy (CBT) has the broadest evidence and is recommended for depression, most anxiety disorders, OCD and PTSD. Other therapies are the better choice for particular problems: EMDR for trauma, DBT for repeated self-harm, family therapy for anorexia in teenagers, interpersonal therapy for depression tied up with relationships.
This page explains what each one involves and what the UK's National Institute for Health and Care Excellence (NICE) — whose guidelines are among the most carefully evidenced in the world — recommends it for. In Pakistan, most qualified clinical psychologists are trained in CBT, and some also offer other approaches; ask what yours uses.
The main therapies, one by one
Cognitive behavioural therapy (CBT)
works on the links between thoughts, feelings, body sensations and behaviour. You learn to notice unhelpful thinking patterns, test them against reality, and gradually stop avoiding what you fear. It is practical, structured and involves homework. Specialised forms include for phobias and OCD, for depression, trauma-focused CBT for PTSD and . For depression, NICE describes individual CBT as usually 8 sessions for less severe and around 16 for more severe depression.
Dialectical behaviour therapy (DBT)
is an adapted form of CBT developed for people who feel emotions very intensely and act on them in ways that hurt — most often self-harm. It combines individual therapy with a weekly skills group teaching four sets of skills: mindfulness, distress tolerance, and getting on with people. NICE suggests considering a comprehensive DBT programme for women with borderline for whom reducing recurrent self-harm is the priority. Programmes typically run for 12 to 18 months.
Acceptance and commitment therapy (ACT)
does not try to argue with difficult thoughts. Instead it teaches you to notice them, make room for them, and still act in line with what you value. NICE recommends ACT or CBT for chronic primary pain — long-lasting pain without a clear physical cause. It is also used for anxiety and depression, where research is growing but less extensive than for CBT.
EMDR
is a trauma therapy. While recalling parts of a traumatic memory, you follow the therapist's hand movements with your eyes (or listen to alternating tones or taps). Why the eye movements help is debated, but the therapy itself has good evidence: NICE recommends offering EMDR to adults with more than three months after a non-combat trauma, usually over 8 to 12 sessions.
Psychodynamic therapy
Psychodynamic therapy explores how feelings and patterns from earlier life, especially within the family, repeat in present relationships — including, sometimes, the relationship with the therapist. It is less structured than CBT. NICE lists short-term psychodynamic psychotherapy, usually 8 to 16 sessions, as an option for depression. Longer, open-ended forms exist but are harder to find and to evidence.
Interpersonal therapy (IPT)
IPT links low mood to what is happening in your relationships: a conflict with a spouse or in-laws, a bereavement, a role change such as marriage, a new baby or retirement, or isolation. It works on those relationships directly. NICE recommends it as an option for depression, typically 8 to 16 sessions.
Family and couples therapy
In family therapy the whole family, not just the person with symptoms, meets the therapist. This fits Pakistani life well, where problems and decisions are shared. NICE recommends anorexia-focused family therapy as a first choice for children and young people with anorexia (typically 18 to 20 sessions over a year), and family intervention for families living with someone who has psychosis or . Behavioural couples therapy is an option when relationship problems are feeding depression, usually 15 to 20 sessions over five to six months.
Group therapy
Most therapies can be delivered in a group of people facing similar problems, with one or two therapists. Sessions are often longer, around 90 minutes. Groups are cheaper, and many people find it a relief to discover they are not the only one. NICE lists group CBT and group programmes among the first options for less severe depression.
Counselling
Counselling is usually shorter and less directive: the counsellor listens, reflects and helps you find your own way through a difficult period. NICE includes a specific evidence-based form of counselling for depression, but general counselling varies widely in quality, especially where the title is unregulated.
What good therapies have in common
Despite their differences, effective therapies share a core: a clear explanation of why the problem persists, a plan agreed with you, a warm and respectful relationship, regular sessions, and something to practise between them. Therapies that offer none of this — no explanation, no goals, no sense of progress — are unlikely to help, whatever they are called.
Children and teenagers usually receive adapted versions. Younger children are often helped most through their parents: parent training programmes teach consistent, warm ways of handling difficult behaviour, and CBT for anxious children involves parents as coaches. Teenagers can do CBT, IPT or family therapy directly. A therapist who works with children should have specific training in doing so.
Side by side
| Therapy | Focus | Best evidenced for | Typical length |
|---|---|---|---|
| CBT | Thoughts, behaviour, avoidance | Depression, anxiety disorders, OCD, PTSD, insomnia | About 5–20 sessions |
| DBT | Managing intense emotions, self-harm | Recurrent self-harm, borderline personality disorder | About 12–18 months |
| ACT | Acceptance and values-based action | Chronic pain; growing evidence for anxiety and depression | Varies; often a few months |
| EMDR | Processing traumatic memories | PTSD | 8–12 sessions, more after multiple traumas |
| Psychodynamic (short-term) | Past patterns in present relationships | Depression | 8–16 sessions |
| Interpersonal therapy | Relationships and life changes | Depression | 8–16 sessions |
| Family therapy | The family system | Anorexia in young people; psychosis (family intervention) | 10–20 sessions over months |
| Group therapy | Shared learning and support | Depression, anxiety, and many others | Often 8 or more weekly sessions |
How to choose
- Start with the problem, not the brand. Tell the psychologist what is wrong and ask which therapy the evidence supports for it.
- Ask about their training in the specific therapy. A weekend workshop in EMDR or DBT is not the same as full training.
- Consider the format. Individual, group, online or in person — the best therapy is the one you can actually attend every week.
- Give it a fair trial. Most people need several sessions before they feel a change. If you see no progress after around six to eight sessions, say so and review the plan.
- Do not stack therapies. Having two different therapies at the same time is generally not recommended; it tends to pull you in two directions.
When talking therapy is not enough on its own
Therapy is powerful, but it is not the only treatment and not always the first. For severe depression, psychosis, or a serious , a psychiatrist's assessment and often medicine are needed alongside it.
What to do next
If you are considering therapy, write down the main problem in one or two sentences, how long it has lasted, and how it affects your day. Take that to a GP or a qualified clinical psychologist and ask which therapy they would recommend and why. That short note will make the first appointment far more useful.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
