What Kind of Therapy Do You Do? (And Why the Answer Isn't as Simple as CBT or EMDR)

If you've spent any time looking for a therapist, you've probably run into what feels like alphabet soup.

CBT.

DBT.

ACT.

EMDR.

IFS.

EFT.

ERP.

Parts and Memory.

Brainspotting.

Narrative Therapy.

Solution-Focused Therapy.

By the time you've read through twenty therapist profiles, you start wondering if you accidentally wandered into an advanced psychology class.

Most people aren't actually trying to become experts in therapy modalities.

They're trying to answer a much simpler question.

"Is this person going to be able to help me?"

It's a Little Like Asking a Mechanic About Their Favorite Wrench

Imagine taking your car to a mechanic because it's making a strange noise.

You probably aren't asking,

"Do you primarily use a torque wrench or a socket wrench?"

You're asking,

"Can you figure out what's wrong?"

Therapy is surprisingly similar.

The tools matter.

The therapist matters.

But perhaps most importantly, knowing when to use a particular tool matters.

No mechanic reaches for the exact same wrench every single time.

No physician prescribes the same medication to every patient.

Likewise, many therapists don't have one single intervention they use with everyone who walks through the door.

Because people aren't all struggling with the same problem.

Even when they have the same diagnosis.

Two People Can Have the Same Diagnosis and Need Completely Different Therapy

Let's imagine two people are both diagnosed with ADHD.

One struggles to remember appointments, loses their keys daily, and wants practical systems that make everyday life feel more manageable.

The other has spent thirty years believing they're lazy, carrying around shame that started long before anyone recognized they were neurodivergent.

On paper?

Same diagnosis.

In reality?

Very different therapy.

Or imagine two people experiencing anxiety.

One wants concrete coping skills to manage panic attacks.

The other realizes their anxiety has always been tied to growing up in a home where they never felt emotionally safe.

Again...

Same diagnosis.

Very different conversations.

That's one of the reasons therapy can't always be reduced to matching a diagnosis with a single modality.

Evidence Matters. So Does the Person Sitting Across From You.

Research is incredibly important.

It tells us which approaches tend to help certain concerns.

Without decades of clinicians and researchers dedicating themselves to therapies like EMDR, DBT, ERP, ACT, CBT, and so many others, our field would be dramatically less effective than it is today. I'm incredibly grateful for the therapists who devote their careers to advancing these approaches, studying them deeply, and helping the rest of us learn from their work.

Interestingly, this is one of the places where the research and my clinical experience overlap quite nicely.

Studies looking at psychotherapy with autistic adults consistently find that the biggest predictors of a helpful therapy experience aren't just the specific modality being used. Clients repeatedly emphasize things like feeling understood, having a therapist who understands neurodivergence, and working with someone willing to adapt therapy to the individual sitting in front of them.

Researchers also found enormous variability in which adaptations people found helpful, reminding us that there isn't one "autistic therapy" or one "ADHD therapy" that works for everyone.

At the same time, research has its limits.

We can measure changes on questionnaires.

We can compare symptom scores before and after treatment.

We can look at large groups of people and identify patterns.

What we can't fully measure is what it feels like to live inside your life.

As therapists, we don't go home with you.

We don't sit beside you during difficult conversations with your partner.

We don't experience your Sunday afternoons, your family dinners, your morning commute, or the thoughts that show up while you're lying awake at two in the morning.

Eventually, you're the one who tells us what's changing.

You're the one who notices that you're speaking more kindly to yourself.

That you're arguing less.

That you're finally looking forward to something again.

That the Sunday dread isn't quite as heavy as it used to be.

Those moments don't always fit neatly onto a questionnaire.

But they're often the moments that matter most.

Sometimes the Most Helpful Moment Isn't in the Workbook.

I work with many thoughtful, insightful, high-functioning adults.

They're often the people who have already read the books.

Listened to the podcasts.

Learned the coping skills.

Completed worksheets before they ever found my office.

That doesn't mean those resources aren't valuable.

Far from it.

Sometimes a workbook is exactly what someone needs.

Sometimes learning distress tolerance skills changes a person's life.

Sometimes EMDR helps a traumatic memory finally feel like it's belongs in the past.

Sometimes ERP gives someone their life back from obsessive-compulsive disorder.

The right modality, at the right time, can be life-changing.

But sometimes...

The breakthrough isn't a worksheet.

It's the moment someone says,

"Wait...I've spent my whole life believing I was the problem."

Or,

"I don't think I've ever actually considered what I want."

Or,

"I thought everyone felt this way."

Those moments aren't less evidence-based because they happen organically.

They're simply what happens when someone finally feels safe enough to connect dots they couldn't see before.

My Goal Isn't to Fit You Into a Modality.

One of the questions I ask myself throughout therapy isn't,

"What's my favorite intervention?"

It's,

"What seems most helpful for this person today?"

Some sessions are practical.

Some are deeply reflective.

Some involve learning new coping skills.

Some involve grieving things that never should have happened.

Some involve getting excited about something completely unrelated to your story.

Some involve laughing because your brain just did something wonderfully human.

The same person might need different approaches at different stages of therapy.

And that's okay.

Therapy isn't about proving that one modality is better than another.

It's about helping you move toward a life that feels more authentic, more connected, and more manageable than the one you walked in with.

The Best Therapy Usually Doesn't Feel Like a Modality.

People sometimes ask me what kind of therapy I do.

The most honest answer is... several.

Not because I can't decide. Of course, there are days like that as well.

But it's mostly because people are wonderfully, honestly, beautifully different.

Good therapy isn't about finding the "best" modality.

It's about finding a therapist who knows enough tools to stay curious with you.

Someone who can teach when teaching is helpful.

Challenge when challenge is needed.

Listen when there aren't any words that can fix what's hurting.

And adjust along the way, because healing rarely follows a perfectly predictable path.

If you find yourself worrying about whether you're going to traumatize your therapist, wondering what they'll think of you after session, or trying to tell your story in a way that feels easier for someone else to hear, know that you're not alone. Trust takes time, especially if you've spent years managing other people's emotions.

But if your primary goal in therapy is protecting your therapist instead of letting yourself be fully known, then we're probably missing the very thing you came to therapy for.

At the end of the day, most people don't leave therapy saying,

"That was excellent CBT."

They leave saying,

"I've never thought about myself that way before."

Or,

"I finally feel like someone understands what I've been trying to explain for years."

For me, that's always been the point.