The choice of therapy type (way of working) varies with the type of difficulty a person is experiencing, how long it has been going on, their expectations and their therapy goals. The Royal College of Psychiatrists (RCPsych) states that the most suitable therapy depends on the type of the problem, its severity and how long it has lasted. This article covers, in general terms, the criteria that can be considered when choosing, questions that can be asked in the first session, the importance of therapeutic fit, and what can be done when the fit does not feel right.
What criteria can be considered when choosing a therapy type?
The sources show that the choice does not depend on a single criterion. The main points that can be considered are:
- Nature of the difficulty: its type, severity and how long it has lasted (RCPsych).
- Goals and expectations: whether the person is looking for a more concrete, goal-oriented and shorter-term piece of work, or a longer-term one aimed at understanding relationship patterns and the effect of the past on the present.
- Preferences about the way of working: whether more structure and direction, or a freely flowing conversation, feels more suitable. Greater Manchester Mental Health NHS Foundation Trust notes that psychodynamic psychotherapy may not be the first choice for people who want more structure or direction.
- Practical circumstances: the frequency and length of sessions and whether they are held in person or online.
- The professional’s qualifications: training, experience and the approach used. Among UK sources, RCPsych says the professional should be properly qualified and registered with a national body, and the NHS advises checking registration with an accredited professional organization.
- Personal fit: RCPsych notes that personal factors are very important.
What is the difference between structured and exploratory approaches?
CBT is a structured approach that focuses mainly on present-day problems, cycles of thoughts, emotions and behaviors, and coping skills; it may be suitable for people looking for a more concrete, goal-oriented and shorter-term way of working. Psychodynamic psychotherapy, on the other hand, focuses on understanding in greater depth a person’s emotional world, the present-day effects of past experiences, recurring relationship patterns and inner conflicts; it may offer a more suitable space for long-standing relationship problems, emotional cycles and difficulties related to one’s sense of self. This distinction is a general tendency, not a verdict; practice varies from one professional to another. For a detailed comparison of the two approaches, see What Is the Difference Between CBT and Psychodynamic Psychotherapy?; for a general overview of approaches, see Which Approaches Can Be Used in the Psychotherapy Process?.
What questions can be asked of the professional in the first session?
NIMH notes that a preliminary conversation with the professional can take place before the process starts, and that the following can be asked:
- The professional’s training, experience and specialty
- The rationale for the approach to be used and the evidence it is based on
- Goals, the recommended number of sessions and how progress will be evaluated
- What will be done if there is no progress
- The scope and limits of confidentiality
For what is covered in the first session, see What Is Covered in the First Session?; for the general framework of psychotherapy, see What Is Psychotherapy?.
Why is therapeutic fit important?
NIMH states that rapport and trust with the professional are essential. A 2018 meta-analysis by Flückiger and colleagues (295 studies, more than 30,000 patients) found a positive association between the therapeutic alliance and therapy outcome (r = 0.278); the association was also seen across different therapy approaches. This is an association and does not by itself show causation; still, it suggests that the working relationship with the professional may deserve as much attention as the name of the approach.
What can be done if the fit does not feel right?
NIMH advises that if there has been no improvement after a reasonable period in therapy, the person first talk with the therapist and, if needed, consider other professionals or approaches. RCPsych notes that a person should not be afraid to look around for someone who suits them, and the NHS notes that during a course of CBT another type of therapy may be recommended if needed. Doubts about the pace, direction or methods of the process can be discussed openly with the professional; such a conversation may help review the way of working together. Because RCPsych does not recommend continuing more than one separate psychotherapy at the same time, it may be appropriate to plan any change by talking it through with the current professional.
Expert note
Choosing a therapy type is less like picking from a menu and more a matter of thinking together about the person’s difficulty, expectations and preferences about the way of working. For some people, structured steps and exercises offer a clearer ground; for others, being able to talk freely and noticing their own patterns over time may be more meaningful.
From a perspective that draws on both cognitive behavioral and psychodynamic theory, thoughts, feelings, behavior and relationship patterns are considered together. Which approach, or which combination of approaches, is suitable usually becomes clear only after an assessment; the information in this article does not replace that assessment.
Clinical Psychologist Özgün Emre Yaylacı
Frequently asked questions
Can a person decide for themselves which approach is suitable?
The sources state that the choice depends on the type, severity and duration of the problem as well as on personal preferences. A person can decide on their own preferences and questions beforehand; however, the suitability of an approach is usually assessed together with the professional in the first session.
What can be done if the fit does not feel right?
NIMH recommends talking with the therapist if there is no improvement after a reasonable period; RCPsych notes that a person should not be afraid to look for someone who suits them.
Is the number of sessions set in advance?
According to RCPsych, the length of the process is in most cases agreed with the professional within about a month of starting. The duration may vary with the nature of the problem and the approach followed.
How can a professional’s qualifications be found out?
NIMH notes that the professional’s training, experience and specialty can be asked about; RCPsych and the NHS stress the importance of the professional being qualified and registered with a professional body. These questions can be asked directly in the first session.
Sources
This article was prepared for general information; the following sources were used in preparing it (in English):
- NIMH (US National Institute of Mental Health): Psychotherapies
- Royal College of Psychiatrists: Psychotherapies and psychological treatments
- NHS (UK National Health Service): Talking therapies
- Greater Manchester Mental Health NHS Foundation Trust: Psychodynamic Psychotherapy
- Flückiger et al. (2018), Psychotherapy: The alliance in adult psychotherapy: A meta-analytic synthesis
This article was prepared by Clinical Psychologist Özgün Emre Yaylacı. Last updated: October 23, 2026. The content is for general information only and does not constitute diagnosis, treatment or personal guidance.
