Alphabet Soup: A Guide to Therapy Modalities and Credentials
If you have ever tried to find a therapist, you have probably encountered a wall of abbreviations. CBT, DBT, ACT, EMDR, LCSW, PsyD. It can be overwhelming and seem needlessly complicated. My hope is that this post helps explain what some of these mean, and can make you a more informed user of these services.
The Families
Psychotherapy is generally thought to be practiced in specific modalities. Modalities include both the theoretical understanding of how therapy works and produces change, as well as the actual steps and actions taken in a therapy “session”. There are many modalities, but they can generally be grouped by a shared history or theoretical stance. We can call those groupings "Families." So, what looks like an overwhelming list of approaches is actually just a handful of variations on a theme, each built around a shared set of ideas about how people change.
The CBT Family
Cognitive Behavioral Therapy (CBT) and its relatives are the most widely practiced and most extensively researched approaches in modern psychotherapy. The core idea is that thoughts (cognitions), behaviors, and emotions are interconnected, and that changing one can change the others. If you can identify and shift unhelpful patterns of thinking or behavior, your emotional experience follows. Change any side of the triangle, and the other sides respond.
CBT was developed by Aaron Beck in the 1950s, and has many offshoots. Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, focuses on the ongoing dialogue (dialectic) one has between what one can change and what one must accept. DBT often focuses on skills training in emotional regulation, distress tolerance, and interpersonal effectiveness, and was originally developed for people with borderline personality disorder but is now used widely. Acceptance and Commitment Therapy (ACT) shifts the focus slightly, emphasizing psychological flexibility and the ability to act in line with your values even in the presence of difficult thoughts and feelings. Rational Emotive Behavior Therapy (REBT), developed by Albert Ellis, focuses on identifying and challenging irrational beliefs.
The CBT family has the strongest research support of any family, in part because these approaches can follow clear, step-by-step structures that lend themselves to standardization and controlled research. It is also fair to say that for specific conditions, particularly anxiety and depression, the current evidence does favor CBT approaches. The picture is more complicated for personality disorders, trauma, and relational difficulties. That’s not to say that research is perfect, and we will discuss the research landscape itself in a later post.
The Psychoanalytic and Psychodynamic Family
These approaches trace their roots to Freud, but modern psychodynamic therapy looks quite different from the classical image of a patient on a couch. The core idea is that unconscious processes, early relational experiences, and patterns that developed in childhood continue to shape how we feel and relate as adults. The therapeutic relationship itself becomes a primary site for exploring the psyche.
Object relations therapy, attachment-based therapy, and relational therapy all fall within this family. The evidence base for psychodynamic approaches has grown considerably in recent decades, though these approaches are historically understudied compared to the CBT family, in part because they are more relational and flexible in nature and practiced over longer time frames, making them harder to standardize and study in controlled trials.
The Humanistic and Existential Family
These approaches share the belief that people have an innate capacity for growth and self-understanding, and that the therapist's job is to create the conditions for that to emerge rather than to direct the process.
Person-centered therapy, developed by Carl Rogers, emphasizes unconditional positive regard, empathy, and genuineness as the core conditions for change. Gestalt therapy focuses on present moment awareness and the integration of fragmented experience, completing experiences or making them whole. Existential therapy engages directly with questions of meaning, freedom, responsibility, and mortality. Person-centered and humanistic approaches have a solid evidence base, particularly for the role of the therapeutic relationship in driving outcomes. Existential approaches are less studied in controlled trials but have strong theoretical and clinical support.
The Somatic Family
These approaches work with the body as well as the mind, based on the understanding that trauma and emotion are stored somatically, not just cognitively. Somatic Experiencing, developed by Peter Levine, focuses on releasing trauma held in the nervous system. Sensorimotor Psychotherapy integrates body awareness with talk therapy. EMDR (Eye Movement Desensitization and Reprocessing), developed by Francine Shapiro, uses bilateral stimulation to help process traumatic memories.
The somatic family as a whole has a growing evidence base. Somatic Experiencing and Sensorimotor Psychotherapy have promising clinical evidence, but fewer large controlled trials than the more established approaches. EMDR has reasonable outcome research, particularly for PTSD, though it sits in an unusual position. Its outcomes are better researched than some somatic approaches, but its proposed mechanism is disputed in ways that place it closer to pseudoscience in some critics’ eyes. We will examine this more closely in a future post.
Internal Family Systems
Internal Family Systems (IFS), developed by Richard Schwartz, does not fit neatly into the other families. It views the mind as containing multiple sub-personalities or parts and works toward internal harmony and integration. Some people find it transformative. Others find the framework adds unnecessary complexity. The research is promising but still developing.
The Wild Cards
Some approaches sit outside the main families and have thinner or more contested evidence bases. Hypnotherapy and various energy-based approaches fall into this category. Some people find them deeply useful, and they tend to be more dependent on therapist skill and client fit than the more structured approaches. These are worth considering if you think it is a good fit for you specifically. If you don’t find them compelling, you’re probably better going with a more researched modality.
This is not an exhaustive list of approaches. Narrative therapy, solution-focused therapy, feminist therapy, and many others exist and are practiced widely. This “families” framework isn’t official, it’s just a way to start making sense of a complicated field. It’s a starting point, not a complete map.
It is also worth noting that therapy is not always individual. Group therapy, couples therapy, and family therapy are delivery formats rather than modalities, and many of the approaches above can be practiced in those contexts. Many therapists also do not practice within a single family. Integrative or eclectic therapists draw from multiple approaches, adapting to what each individual client needs. This flexibility is often a strength rather than a lack of focus.
A Note on Research
The CBT family dominates the research literature, but this is partly a function of how easy these approaches are to study rather than proof that they are universally superior. Psychodynamic and humanistic approaches have solid and growing evidence bases. It is also worth noting that psychology and social science research has its own limitations and blind spots, which we will examine in a future post.
The Credential Alphabet
The letters after a therapist's name tell you about their training and licensure, not necessarily their quality or fit for you. Here is a plain language guide.
MD (Medical Doctor) / Psychiatrist — A psychiatrist is a medical doctor who specializes in mental health. They can prescribe medication. Some also provide therapy, but many focus primarily on medication management.
PhD (Doctor of Philosophy) / PsyD (Doctor of Psychology) — Both are doctoral-level psychologists. A PhD is typically more research-focused. A PsyD is a clinical doctorate designed specifically for practice. Both can provide therapy and psychological testing. Neither can prescribe medication in most states.
LCSW (Licensed Clinical Social Worker) — A master's level clinician trained in both clinical practice and the social and environmental factors that affect mental health. In Montana, the candidate designation (SWLC) indicates someone working toward full licensure under supervision. Many people do not think of social workers as therapists, but they should. Clinical social workers are the largest group of mental health providers in the United States, outnumbering psychiatrists, psychologists, and psychiatric nurses combined. What makes the social work perspective distinctive is its attention to the whole person and not just symptoms. The LCSW looks at the context of someone's life, relationships, community, and circumstances.
LCPC (Licensed Clinical Professional Counselor) / LPC (Licensed Professional Counselor) — Master's level clinicians whose credential grew out of more specialized counseling contexts like addiction, school, and career counseling. The training emphasis differs somewhat, but the therapy is often identical to an LCSW.
MFT (Marriage and Family Therapist) — Master's level clinicians focusing on couples, families, and relationship dynamics. They are trained to look at the person not just as an individual but as part of a larger web of relationships and family patterns.
A note on insurance: credentials can affect reimbursement, so it is worth checking with your insurance provider before booking to confirm what is covered.
What the Letters Don't Tell You
The modalities and credentials matter less than you might think. As we discussed in the previous post, the research consistently points to the therapeutic relationship as the strongest predictor of outcome. A highly credentialed therapist using the most evidence-based approach will not be effective if the relationship is not there. Finding someone you trust, feel comfortable with, and can be honest with matters more than any letters after their name.
Mike O'Rourke is a Licensed Clinical Social Worker Candidate in Montana, available for in-person and telehealth therapy. Book a session or consultation.