When a therapist lists a modality on their profile, they're describing a specific treatment approach with its own theory, techniques, and evidence base. For clients, these terms can feel like jargon. Knowing what each one means — and what to expect in actual sessions — helps you ask better questions, assess a therapist's real training, and choose an approach that fits how you process.
This reference covers 19 modalities commonly used by Tandem-listed therapists. Each entry answers the same five questions: What is it? What does a session actually look like? Who tends to benefit? What training should a qualified therapist have? And what should you ask before your first appointment?
EMDR
What it is
EMDR is a structured, 8-phase trauma treatment that uses bilateral stimulation — most commonly guided eye movements — to help the brain process traumatic memories that have become "stuck." The theory is that overwhelming experiences sometimes get stored in a maladaptive form that preserves the original emotions, physical sensations, and distorted beliefs. By activating the memory while simultaneously engaging in bilateral stimulation, EMDR facilitates the brain's natural information processing, allowing memories to be integrated without carrying the same emotional charge. Unlike CPT or CBT, EMDR does not require detailed verbal analysis of what happened — the processing occurs through the bilateral stimulation itself.
What a session looks like
Your therapist will ask you to briefly bring a specific memory to mind — the image, associated thoughts, feelings, and body sensations — while following their fingers (or a light bar, or alternating tones) with your eyes. You do this in sets, periodically pausing to report what comes up. The content often shifts on its own: new images, associations, or insights arise without the therapist directing them. Sessions typically run 60–90 minutes. Early sessions focus on history-taking and building internal resources before any trauma processing begins.
Who tends to benefit
- Single-event trauma, PTSD, or complex trauma (with a phased approach)
- Those who prefer less verbal processing of traumatic events
- Anxiety, phobias, or distress with a clear trigger event
- Somatic or body-aware individuals
- Children and adolescents (adapted protocols available)
Training to look for
EMDRIA-approved training involves a Part 1 and Part 2 weekend course, followed by supervised practice and consultation hours. Full EMDRIA Certification requires 20+ hours of consultation from an EMDRIA-approved consultant. "EMDRIA Certified" is a higher standard than "EMDRIA Trained." Completing the introductory training is the first step — supervised practice and consultation hours are what prepare a therapist to deliver EMDR with clinical fidelity.
Questions to ask
- "Are you EMDRIA Certified, or EMDRIA Trained — and what's the difference in your training?"
- "How many EMDR sessions have you delivered?"
- "Do you follow the full 8-phase protocol, or do you adapt elements of it?"
CBT
What it is
CBT is based on the insight that how we interpret events shapes how we feel and behave — and that changing unhelpful thought patterns and behaviors produces meaningful relief. It is highly structured and time-limited. You'll identify automatic thoughts (the rapid, often unconscious interpretations that color your experience), examine the evidence for and against them, and develop more balanced alternatives. Simultaneously, you'll address the behavioral patterns that maintain problems — avoidance being the most common. CBT is not about positive thinking; it is about accurate thinking and deliberate behavioral change backed by ongoing practice.
What a session looks like
Sessions follow a consistent structure: review of homework from the previous week, setting an agenda, skill-building or cognitive restructuring work, and assigning new practice tasks. Your therapist may walk you through a "thought record" — a worksheet examining the logic behind a distressing thought. Sessions are active and collaborative; you are both working on specific material, not processing in a free-associative way.
Who tends to benefit
- Anxiety disorders — generalized anxiety, social anxiety, panic, specific phobias
- Depression and low mood
- Insomnia (CBT-I is the gold standard for insomnia)
- Chronic pain and health anxiety
- Those who are comfortable with structured work and consistent homework
Training to look for
CBT is broadly covered in graduate training, but specialization varies significantly. Look for therapists who identify specific CBT protocols for your concern (e.g., CBT for panic disorder vs. CBT-I for insomnia — these are distinct protocols). Ask about supervised CBT cases and whether they deliver full protocols vs. a loosely CBT-informed approach.
Questions to ask
- "What specific CBT protocol do you use for my concern?"
- "How much homework is typically involved?"
- "How many sessions do you find this issue usually takes?"
DBT
What it is
DBT was originally developed for people with borderline personality disorder and chronic suicidality — two groups historically underserved by existing treatments. At its core is a central dialectic: accepting yourself exactly as you are right now while simultaneously working to change. DBT teaches four concrete skill sets: mindfulness (present-moment awareness without judgment), distress tolerance (surviving crises without making things worse), emotional regulation (understanding and managing intense emotions), and interpersonal effectiveness (communicating clearly while maintaining self-respect). Comprehensive DBT is an intensive model — individual weekly therapy plus a weekly skills group plus between-session phone coaching.
What a session looks like
Individual DBT sessions begin with reviewing the week's diary card — a daily log of emotional intensity, urges, and skill use. Sessions target behaviors in a specific hierarchy: life-threatening behaviors first, then therapy-interfering behaviors, then quality-of-life issues. Your therapist will use validation — genuinely acknowledging the logic of your responses given your history — alongside direct coaching on applying skills to the current week's challenges.
Who tends to benefit
- Intense, rapidly shifting emotions or chronic emotional dysregulation
- Patterns of self-harm or suicidal thoughts
- Borderline personality disorder or BPD traits
- Eating disorders with significant emotional dysregulation
- Those who have found standard therapy insufficient or have "graduated" from CBT
Training to look for
Training through the Linehan Institute or an LCDBT-certified program. A key question is whether they offer a skills group alongside individual therapy — many therapists use "DBT skills" in individual sessions, which is less potent than the full comprehensive model. Offering individual DBT only, without a skills group, is a common departure from the validated treatment.
Questions to ask
- "Do you offer comprehensive DBT with a skills group, or DBT skills in individual therapy only?"
- "Are you trained through the Linehan Institute or an LCDBT-approved program?"
- "How long does your DBT program typically run?"
ACT
What it is
ACT (pronounced as one word, "act") takes a different stance from traditional CBT. Rather than changing the content of difficult thoughts and feelings, ACT teaches you to change your relationship to them — to hold them more lightly, observe them without being fused with them, and choose your behavior based on your values rather than your emotional state. The core insight is that psychological suffering often comes not from painful experiences themselves, but from our attempts to avoid, control, or eliminate them. ACT uses acceptance, mindfulness, defusion (learning to see thoughts as thoughts, not facts), and values clarification to help people move toward a meaningful life even amid ongoing difficult inner experiences.
What a session looks like
ACT sessions blend experiential exercises, metaphors, and mindfulness practices with values clarification work. You might spend time identifying what matters most to you — relationships, creativity, contribution — and then mapping the gap between where you are and where you want to be. Your therapist may use metaphors (the "passengers on the bus" metaphor is common) to help you notice how much energy goes into fighting your inner experience vs. moving toward what actually matters.
Who tends to benefit
- Anxiety and depression, especially when avoidance is central to the pattern
- Chronic pain or chronic illness
- Those who have tried CBT without full success
- Grief, loss, or values conflicts
- Those drawn to a mindfulness-informed, less technique-driven approach
Training to look for
The Association for Contextual Behavioral Science (ACBS) offers peer-reviewed therapist status and training resources. Ask whether they've completed formal ACT training beyond a single introductory workshop, and whether they have supervised ACT cases.
Questions to ask
- "How do you use ACT differently from standard CBT in practice?"
- "What role do values play in how you structure treatment?"
- "Do you practice mindfulness yourself, and how does that show up in sessions?"
EFT
What it is
EFT is built on attachment theory — the understanding that humans are biologically wired for close emotional bonds, and that relationship distress reflects disruptions in the security of that bond. The central insight is that the same negative interaction pattern activates repeatedly in distressed relationships: one partner pursues, criticizes, or escalates while the other withdraws, stonewalls, or minimizes. EFT therapists help partners slow down and enter the softer, more vulnerable feelings underneath these reactive positions — the fear, the longing, the grief — and share them in a way the other person can actually receive. The goal is to reshape the emotional bond itself, not just teach communication techniques.
What a session looks like
Sessions involve all three of you — therapist and both partners. Your therapist will track the interaction pattern in real time ("I notice when you say X, your partner seems to pull away — what's happening for you in that moment?") and work to slow down the cycle so underlying emotions surface. You may be asked to turn directly to your partner and share something vulnerable while the therapist supports the exchange. Progress in EFT is measured by shifts in the emotional bond, not just changes in communication behavior.
Who tends to benefit
- Couples experiencing disconnection, chronic conflict, or emotional distance
- Partners with anxious or avoidant attachment styles
- Infidelity recovery (often used alongside specific affair recovery protocols)
- Sexual dissatisfaction rooted in emotional disconnection
- Individuals processing attachment wounds in individual EFT
Training to look for
ICEEFT (International Centre for Excellence in Emotionally Focused Therapy) certification. Therapists can be EFT Trained, EFT Supervisor Candidate, or EFT Certified — the last being the highest standard. Ask whether they've completed the full ICEEFT training sequence with supervised cases and ongoing consultation.
Questions to ask
- "Are you ICEEFT Trained or Certified in EFT?"
- "How do you use attachment theory in your approach to couples work?"
- "What does the first month of couples work typically look like with you?"
IFS
What it is
IFS is based on the understanding that the mind naturally divides into distinct "parts" — not as a sign of pathology, but as a normal feature of human psychology. Different parts hold different beliefs, emotions, and roles. IFS distinguishes between protective parts (Managers, who try to keep difficult feelings at bay proactively; Firefighters, who react impulsively when pain breaks through) and Exiles (parts carrying the burden of past trauma or pain). Underlying all parts is the Self — a stable, compassionate core that can lead the internal system when it isn't overwhelmed. IFS therapy involves developing a relationship with your parts, understanding what they're protecting, and ultimately unburdening the exiled pain they carry.
What a session looks like
Your therapist will invite you to focus inward and notice what you're experiencing — thoughts, feelings, images, physical sensations — then ask questions like "How do you feel toward that part?" and "What is it afraid would happen if it relaxed?" Sessions proceed at the pace of trust between you and your internal system. IFS is often slower and more exploratory than CBT, and it is frequently combined with EMDR for trauma processing once protective parts have given permission.
Who tends to benefit
- Trauma and PTSD, particularly complex or developmental trauma
- Pervasive self-criticism, shame, or self-destructive patterns
- Those who have found symptom-focused therapy insufficient
- People interested in understanding their inner world, not just managing symptoms
- Relational patterns that keep repeating despite insight
Training to look for
IFS Institute Level 1, 2, and 3 training; Program Assistant (PA) experience adds significant depth. Therapists can also become IFS Certified Practitioners. Ask whether they've completed at minimum Level 1 training (a 6-day intensive). Many therapists describe their work as "IFS-informed" after reading the books without completing formal training — these are very different levels of preparation.
Questions to ask
- "How many IFS training intensives have you completed, and at which level?"
- "How do you use IFS with trauma specifically — do parts need to give permission before processing?"
- "Do you ever integrate IFS with EMDR or somatic work?"
Somatic Therapy
What it is
Somatic therapy is grounded in the understanding that trauma is a bodily experience, not just a cognitive or emotional one. When we experience overwhelming events, the nervous system activates a stress response — fight, flight, or freeze — and sometimes gets "stuck" in that activated state long after the event has passed. This shows up as chronic tension, hypervigilance, dissociation, numbness, or unexplained physical symptoms. Somatic therapy focuses on helping the body complete the interrupted stress response and restore nervous system regulation. Rather than working primarily through narrative (what happened), you work through sensation — what the body is doing right now.
What a session looks like
Your therapist will frequently check in with what you're noticing physically — tension, ease, constriction, warmth, movement impulses. They may invite slow adjustments to posture, attention to a particular area, or gentle movements. The pace is deliberately slow to avoid overwhelming the nervous system. Sessions may feel different from traditional talk therapy — there can be meaningful pauses, and what seems like "nothing happening" is often significant internal regulation work.
Who tends to benefit
- Trauma where talk therapy hasn't brought sufficient relief
- Chronic pain or unexplained somatic symptoms
- Dissociation, numbness, or feeling "cut off" from the body
- Hypervigilance, startle responses, or chronic nervous system activation
- Those who find purely verbal processing emotionally activating without resolution
Training to look for
For Somatic Experiencing: the SEP (Somatic Experiencing Practitioner) credential from Somatic Experiencing International, requiring 216 hours over approximately 3 years. For Sensorimotor Psychotherapy: Level 1 and 2 training through the Sensorimotor Psychotherapy Institute. Many therapists describe themselves as "somatic" after attending one or two workshops — ask specifically what credential or training program they've completed.
Questions to ask
- "What somatic training have you completed — SE, Sensorimotor, or another approach?"
- "Do you hold the SEP credential or equivalent?"
- "How do you integrate body-based work with talk therapy?"
Psychodynamic Therapy
What it is
Psychodynamic therapy explores how experiences from your past — particularly early relationships — have shaped unconscious patterns that play out in your current life. These patterns include characteristic ways of relating to others, defenses against painful feelings, and the narratives you've built about yourself and the world. Unlike CBT, psychodynamic therapy doesn't follow a fixed session structure or assign worksheets. The content emerges from what you bring — dreams, memories, current relationships, recurring themes. The therapist-client relationship itself becomes a window into these patterns, and the therapist will draw attention to recurring themes, what might be operating out of awareness, and what seems to be avoided.
What a session looks like
Sessions typically begin with you speaking about what's on your mind — what has come up since last time, recurring thoughts, significant experiences. Your therapist will listen for themes, make links between different areas of your experience, and reflect back patterns they're noticing. They may point out what you seem to be avoiding or comment on what's happening between the two of you in the room. Sessions are less directed than CBT and more reflective in character.
Who tends to benefit
- Long-standing emotional or relational patterns that haven't responded to shorter-term approaches
- Depression or anxiety with characterological features
- Relational difficulties — patterns that keep repeating across relationships
- Those seeking self-understanding as a goal, not just symptom reduction
- Those curious about their own psychology and drawn to deeper exploration
Training to look for
Psychodynamic training ranges from brief graduate-level exposure to multi-year postdoctoral psychoanalytic institutes. Ask about supervised psychodynamic cases and any post-degree specialized training in a specific framework — object relations, relational, self-psychology, and attachment-based psychodynamic work are distinct approaches. More intensive training generally means deeper expertise in working with complex presentations.
Questions to ask
- "How long have you been practicing psychodynamically, and what theoretical frameworks inform your work?"
- "How active vs. reflective are you in sessions — do you offer interpretations or primarily follow?"
- "How do you think about the relationship between past patterns and current symptoms?"
Trauma-Informed Care
What it is
Trauma-Informed Care is not a treatment protocol with specific techniques — it's a framework that shapes how a therapist understands and approaches every client. A trauma-informed therapist assumes that many clients have experienced trauma (whether or not they identify it as such), and that trauma affects physiology, emotional regulation, cognition, and relationships in pervasive ways. This changes the clinical environment: pacing, power dynamics, the language used, how disagreements are handled, whether the client is given genuine choice and control. TIC is the necessary foundation beneath specific trauma treatments — a therapist who technically delivers EMDR but is not trauma-informed in their general attunement can inadvertently retraumatize through poor pacing or insensitive framing.
What a session looks like
There's no "trauma-informed session" per se — it shows up as a general orientation. A trauma-informed therapist will check in about pace and comfort, ask before introducing techniques, normalize responses without judgment, never pressure or shame, and attend to how power dynamics in the room might mirror earlier dynamics. Informed consent is thorough and ongoing, not just a form signed at intake.
Who tends to benefit
- Anyone with a history of significant adversity, neglect, or trauma
- Clients from marginalized communities with history of systemic harm
- Medical trauma survivors or those with chronic illness
- Those who have had prior negative or retraumatizing therapy experiences
- People whose trauma does not fit a single-incident PTSD presentation
Training to look for
SAMHSA's six principles of trauma-informed care provide a common framework; training ranges from graduate coursework to specialized certifications. Because TIC is a framework rather than a protocol, the most meaningful indicator is how a therapist talks about it — whether they can articulate how it shapes their specific practice, not just that they're aware of it.
Questions to ask
- "How do you think about trauma's role in your clients' presenting concerns — even when trauma isn't the stated reason for seeking therapy?"
- "How do you handle it if a client becomes overwhelmed during a session?"
- "What does ongoing informed consent look like in your practice?"
Mindfulness-Based Therapy
What it is
Mindfulness-Based therapies are rooted in the practice of paying deliberate, non-judgmental attention to present-moment experience — thoughts, feelings, sensations — without getting caught in reacting to them. MBSR, developed at UMass Medical Center, is an 8-week program using meditation, yoga, and body scan practices primarily for chronic stress, pain, and illness. MBCT adapts this for depression, adding cognitive therapy elements to help people recognize the early warning signs of depressive relapse and disengage from the ruminative thought patterns that precede it. MBCT is one of the few therapies recommended by NICE (UK's clinical guidelines body) as a first-line option for preventing recurrent depression.
What a session looks like
In structured MBSR or MBCT, sessions involve guided meditation and body scan exercises, group discussion of practice, and teaching specific skills like the "three-minute breathing space." In individual mindfulness-based work, your therapist will help you apply mindful awareness to difficult thoughts and feelings — observing them as mental events rather than facts about reality — and assign daily home practice.
Who tends to benefit
- Recurrent depression (especially three or more prior episodes) — MBCT is specifically indicated
- Chronic stress, anxiety, or pain
- Those drawn to a practice-based, contemplative approach
- People who want to develop an ongoing mindfulness practice, not just receive a treatment
- Those seeking relapse prevention rather than acute symptom relief
Training to look for
MBSR teacher certification through UMass Center for Mindfulness or affiliated programs; MBCT certification through specific accredited training programs including Brown University's Mindfulness Center. Many therapists "integrate mindfulness" without having formal training in the structured protocols — ask whether they offer the actual 8-week program or mindfulness-influenced individual therapy.
Questions to ask
- "Have you completed formal MBSR or MBCT teacher training?"
- "Do you offer the structured 8-week program, or do you integrate mindfulness into individual therapy?"
- "Do you have your own ongoing mindfulness practice?"
TF-CBT
What it is
TF-CBT is specifically designed for children and adolescents (ages 3–18) who have experienced trauma, and it always includes a caregiver component — parents or guardians participate in parallel sessions and joint sessions with the child. The protocol follows the acronym PRACTICE: Psychoeducation, Relaxation, Affective regulation, Cognitive coping, Trauma narrative development and processing, In vivo mastery of trauma reminders, Conjoint child-parent sessions, and Enhancing safety. The caregiver involvement is not optional — research shows that parental participation significantly improves outcomes, and the parent's ability to support the child's processing is central to the model.
What a session looks like
Child sessions blend psychoeducation (teaching about trauma responses in age-appropriate ways), skill-building (relaxation and emotional regulation), and gradual trauma narrative work — the child tells and then processes the story of what happened, with the therapist helping develop more balanced beliefs. Caregiver sessions happen concurrently, preparing the parent to support the child and process their own emotional responses. Joint sessions toward the end of treatment allow parent and child to share and connect around the experience.
Who tends to benefit
- Children and adolescents (ages 3–18) who have experienced sexual abuse, physical abuse, domestic violence, traumatic loss, or other traumatic events
- Presentations including PTSD, depression, anxiety, and behavioral problems following trauma
- Caregivers who are themselves struggling with the child's trauma disclosure or experience
- Families where the caregiver can participate actively in treatment
Training to look for
The National Therapist Certification Program (NTCP) through the Medical University of South Carolina. TF-CBT Web is a required online course, but full certification requires additional supervised cases and consultation. Ask whether they hold formal TF-CBT certification — not just completion of the online course.
Questions to ask
- "Are you TF-CBT certified through the MUSC program?"
- "How do you involve parents — do they attend separate sessions, and how often?"
- "At what point in treatment does the trauma narrative typically begin?"
Gottman Method
What it is
The Gottman Method is built on John Gottman's longitudinal research observing thousands of couples — research that identified patterns predicting divorce with over 90% accuracy. These include the Four Horsemen (criticism, contempt, defensiveness, and stonewalling), emotional flooding that shuts down productive communication, and the failure to respond to bids for connection. Gottman Method therapy works on three interconnected levels: building friendship (the foundation of a stable relationship), learning to manage conflict without it becoming destructive, and creating shared meaning and life dreams together. It uses formal assessments and specific, teachable skills at each level.
What a session looks like
Sessions include both partners. Your therapist may administer the Gottman Relationship Checkup (an extensive online assessment), review responses together, and work on specific skills — "softened startup" for difficult conversations, physiological self-soothing before conflict discussions, or building "turning toward" behaviors in daily life. Sessions are structured and concrete, often focused on a specific interaction pattern identified from the assessment or from in-session observation.
Who tends to benefit
- Couples with significant conflict or communication difficulties
- Couples recovering from infidelity (often combined with Gottman's affair recovery protocol)
- Couples experiencing emotional distance, parallel lives, or chronic disconnection
- Pre-marital couples seeking to build a strong foundation
- Partners who appreciate a structured, research-grounded approach
Training to look for
Gottman Institute Levels 1, 2, and 3. Level 1 is a 2-day workshop; Level 3 includes clinical case review with Gottman trainers and represents substantially deeper training. Many therapists list "Gottman Method" after completing only Level 1 — ask what level they've completed.
Questions to ask
- "What level of Gottman training have you completed — 1, 2, or 3?"
- "Do you use the Gottman Relationship Checkup as part of your intake?"
- "How do you adapt Gottman for affair recovery?"
Brainspotting
What it is
Brainspotting emerged from EMDR when David Grand noticed that a client's eyes spontaneously fixed at a particular position just before a significant therapeutic breakthrough. The premise is that where you look affects where the brain processes — and that finding a "brainspot" (an eye position correlated with activation in the subcortex where trauma is stored) creates a focused access point for processing. Unlike EMDR's rhythmic bilateral stimulation, Brainspotting uses a sustained fixed eye position, often with biolateral music in the background. It is often described as more "relational" and less protocol-driven than EMDR — therapist and client co-discover what's present, guided by the body's responses rather than a structured set of phases.
What a session looks like
Your therapist will guide your gaze to different positions while tracking your internal activation — distress level, body sensation, emotional intensity. When they identify a brainspot, they'll invite you to hold that gaze position and observe what comes up internally. Sessions may feel deeply inward and contemplative. Some clients experience significant emotional releases; others notice subtle physical sensations or shifts in associated imagery. The therapist stays present and engaged throughout rather than directing content.
Who tends to benefit
- Trauma and PTSD, including those with partial results from EMDR
- Performance anxiety, creative blocks, or athletic performance issues
- Those who find EMDR's bilateral stimulation distracting or activating
- Somatic symptoms without a clear trauma narrative
- Clients who want a body-based approach that feels less structured
Training to look for
Brainspotting Phase 1 and Phase 2 trainings; advanced intensives are available. Phase 2 includes more sophisticated protocol work. The Brainspotting International website maintains a practitioner directory. Ask whether they've completed Phase 2 — Phase 1 alone is introductory.
Questions to ask
- "How many Brainspotting trainings have you completed, and up to which phase?"
- "How do you decide when to use Brainspotting vs. EMDR?"
- "How do you integrate Brainspotting with talk therapy?"
Play Therapy
What it is
For children, play is not frivolous — it is their primary language for processing experience, exploring relationships, and communicating things they can't yet articulate verbally. Play therapy creates a consistent, safe space where children can use toys, sand trays, art, and creative play to express and work through difficult experiences at their own pace. Child-Centered Play Therapy (based on Virginia Axline's approach, rooted in Carl Rogers' person-centered principles) emphasizes the child's agency and the therapist's unconditional positive regard. More directive play therapy approaches use specific techniques or structured activities. Filial Therapy extends the model by training parents to conduct child-centered play sessions at home.
What a session looks like
A play therapy room is stocked with specific categories of toys — nurturing items, aggressive toys, expressive art materials, figures, and a sand tray. The therapist observes and reflects the child's play without directing it, tracking themes and making reflections like "That seems really frustrating" or "The little figure seems scared." Themes and resolution often emerge over time through the symbolic language of play. The therapist typically meets separately with parents to report on themes and progress.
Who tends to benefit
- Children ages 3–12 experiencing anxiety, depression, trauma, or behavioral problems
- Children processing grief, family disruption, or adjustment difficulties
- Young people for whom verbal processing is developmentally limited or situationally difficult
- Children where prior talk-based approaches have been insufficient
Training to look for
Registered Play Therapist (RPT) credential through the Association for Play Therapy (APT), requiring 150+ hours of supervised play therapy and 50+ hours of play therapy-specific training beyond a graduate degree. Ask whether they hold the RPT credential — many therapists "do play therapy" without this specialized training.
Questions to ask
- "Are you a Registered Play Therapist (RPT)?"
- "What play therapy model do you primarily use — child-centered, directive, or sand tray?"
- "How do you involve parents — separate sessions, joint sessions, or Filial Therapy?"
ERP
What it is
ERP targets OCD's core engine: the cycle of obsession → anxiety → compulsion → temporary relief → return of obsession. Exposure involves deliberately confronting the thoughts, images, objects, or situations that trigger obsessional fear. Response prevention means refraining from the compulsive behavior — checking, reassurance-seeking, mental reviewing, avoidance — that would normally relieve the anxiety. Done repeatedly, this teaches the brain that the feared outcome doesn't occur and that anxiety decreases on its own without the compulsion. ERP works for all OCD subtypes, including Pure O (primarily mental compulsions like mentally reviewing, counting, or seeking internal reassurance) — a form that many therapists without OCD specialization fail to recognize.
What a session looks like
After thorough assessment of your specific OCD (feared consequences, compulsive behaviors, avoidance), your therapist builds an exposure hierarchy — a ranked list of triggers from least to most distressing. Sessions involve practicing exposures in order, starting lower on the hierarchy and advancing as you build tolerance. Your therapist should be actively engaged during exposures, not passive. Between sessions, you practice independently, which is where much of the actual learning occurs.
Who tends to benefit
- OCD in all subtypes — contamination, harm, sexual or religious intrusive thoughts, symmetry, Pure O
- Body dysmorphic disorder (BDD)
- Illness anxiety and health OCD
- Specific phobias (using exposure without the response prevention component)
Training to look for
IOCDF (International OCD Foundation) maintains a therapist directory of providers with verified OCD specialization. Ask whether they specialize in OCD specifically — not just anxiety generally. A critical red flag: recommending "anxiety management," relaxation, or reassurance strategies as the primary treatment for OCD. These can provide temporary relief but reinforce the compulsion cycle and often make OCD worse long-term.
Questions to ask
- "Do you specialize in OCD? How many OCD clients are currently in your caseload?"
- "How do you handle Pure O — obsessions without obvious external compulsions?"
- "What role do relaxation techniques or anxiety management play in your OCD treatment?"
PACT
What it is
PACT is a couples therapy model developed by Stan Tatkin that integrates three bodies of research: attachment theory (how early bonds shape how we relate), arousal regulation (how the nervous system manages states of activation and calm), and interpersonal neurobiology (how two nervous systems co-regulate each other). The central premise is that most relationship conflict is not primarily about the content of disagreements — it's about nervous system states. When partners are dysregulated (flooded, shut down, or in crisis), they lose access to empathy, nuance, and problem-solving. PACT helps partners learn to read each other's physiological states accurately and regulate each other's nervous systems through deliberate attunement.
What a session looks like
PACT sessions are active and often directive. Your therapist may use video playback or live observation to help partners see their interaction from outside. Partners may be asked to face each other and maintain eye contact while working through something difficult — activating the nervous system in session to practice regulating in real time. Your therapist will call out exactly what is happening moment to moment: "When you looked away there, what happened in your partner's face?"
Who tends to benefit
- Couples experiencing chronic conflict driven by nervous system dysregulation
- Anxious-avoidant attachment pairings (one pursuer, one withdrawer)
- Partners who re-enact childhood attachment dynamics in the relationship
- Couples who've tried other couples therapy without sustained improvement
- Those interested in the neuroscience of relationships
Training to look for
PACT Level 1 and Level 2 training through the PACT Institute; PACT Certified Therapist is the highest credential. Ask what level they've completed — Level 1 is introductory and Level 2 represents substantially more training and supervised cases.
Questions to ask
- "What PACT level are you trained to, and do you hold the PACT Certified Therapist credential?"
- "How do you use the concept of the couple bubble in your work?"
- "Do you see partners individually at intake, together, or both?"
Sensorimotor Psychotherapy
What it is
Sensorimotor Psychotherapy (SP) is a body-centered approach to trauma and attachment developed by Pat Ogden. It recognizes that trauma and early attachment experiences are stored not just in explicit memory but in the body — as movement tendencies, posture, gestures, and physical sensations that operate outside conscious awareness. SP works with these somatic patterns directly by attending to the body's moment-to-moment experience as the client accesses difficult material. Rather than talking about the body, SP works with the body: helping clients complete interrupted defensive or orienting responses that became "frozen" at the time of trauma. It draws on neurobiological models of trauma, attachment, and dissociation, and is often used with clients who have complex trauma or who require careful grounding before processing.
What a session looks like
Your therapist will regularly direct attention to physical experience — what your posture is doing, where tension or ease is held, what happens in your body when you say something emotionally loaded. They may invite micro-movements: slightly adjusting posture, following an impulse to reach forward or pull back, completing a movement that the body seems to want. The pace tends to be slow and careful. SP is frequently used with clients who have dissociation, as it provides grounding resources before and during trauma processing.
Who tends to benefit
- Complex trauma and PTSD, particularly developmental or early relational trauma
- Dissociation, depersonalization, or emotional numbness
- Chronic somatic symptoms or bodily responses without clear physical cause
- Those for whom purely verbal therapy has been insufficient
- People interested in understanding the body-trauma connection directly
Training to look for
Sensorimotor Psychotherapy Level 1 and Level 2 training through the Sensorimotor Psychotherapy Institute (SPI). Level 1 is foundational; Level 2 focuses specifically on trauma and character development. Ask whether they've completed formal SPI training — as with other somatic approaches, many therapists describe themselves as "sensorimotor-informed" after reading rather than after training.
Questions to ask
- "What level of Sensorimotor Psychotherapy training have you completed through SPI?"
- "How do you integrate somatic work with talk therapy — does it replace it or run alongside?"
- "How do you work with dissociation when it comes up during body-focused work?"
Gestalt Therapy
What it is
Gestalt therapy is a humanistic, experiential approach based on the principle that present-moment awareness is itself therapeutic. Rather than excavating the past or analyzing cognitions, the focus is on what is alive right now — what you're feeling in your body, how you're relating to the therapist, and what patterns keep showing up in the here and now. The word "Gestalt" means "whole" in German; the approach emphasizes that fragmented parts of experience need to be brought into awareness and integrated, not intellectualized. Unfinished emotional business from past relationships — grief not fully processed, anger suppressed, needs never spoken — tends to resurface in present behavior. Gestalt works with that material directly in the room.
What a session looks like
Sessions are active and relational. The therapist might draw your attention to a gesture you just made, invite you to stay with an emotion rather than move past it, or use experiential techniques like the empty chair — where you speak to an absent person or a part of yourself as if they were present. Role play, creative expression, and heightened attention to body cues are common. The therapist participates as a genuine person in the exchange rather than maintaining a neutral stance; the quality of the relationship is considered part of the treatment, not just a delivery vehicle for it.
Who tends to benefit
- Unfinished grief, loss, or relational trauma from earlier in life
- People who feel emotionally disconnected or cut off from their bodies
- Existential questioning, identity work, or major life transitions
- Those who find traditional talk therapy too cerebral or distant
- Anxiety and depression stemming from suppressed emotion or unmet needs
Training to look for
Gestalt training typically involves multi-year immersive programs through accredited institutes — such as GATLA (Gestalt Associates Training Los Angeles), the Gestalt Institute of Cleveland, or similar programs. Gestalt training requires a multi-year commitment — personal therapy, experiential group work, and supervised practice — that extends well beyond introductory coursework. Ask specifically about the name, length, and format of their training program.
Questions to ask
- "What Gestalt training program did you complete, and over what period of time?"
- "How do you use the therapeutic relationship itself in your work?"
- "Do you use experiential techniques like empty-chair work — and what guides when you introduce them?"
Psychotherapy
What it is
When a therapist lists "psychotherapy" as their approach, they typically mean they practice integrative or insight-oriented talk therapy that draws on multiple theoretical traditions rather than following a single strict protocol. Psychotherapy is the umbrella term for the entire field — all CBT, DBT, EMDR, and Gestalt are forms of psychotherapy — but in common usage, it often signals a more flexible, relational style where the therapist adapts their approach to the person rather than applying a fixed technique. The therapeutic relationship, exploration of patterns, and deepening self-understanding are central goals. This is distinct from more structured, manualized approaches where every session follows a prescribed format.
What a session looks like
Sessions feel more conversational than highly structured approaches like CBT. There is typically no homework or agenda review; instead, you bring what is on your mind and the therapist helps you explore it with depth. The therapist may reflect patterns they notice, make connections between the present and the past, or simply create the space for material to surface naturally. Sessions tend to be 50–55 minutes and may feel less immediately tangible than technique-focused therapy — the change often happens gradually through the ongoing relationship and developing insight.
Who tends to benefit
- Long-standing patterns in relationships, self-esteem, or mood that feel hard to pinpoint
- People who value depth and self-understanding over skill-building
- Those who want a collaborative, relational therapy experience
- When a single diagnosis or presenting concern doesn't capture the whole picture
- Clients who have tried structured approaches and want something less prescribed
Training to look for
Any licensed therapist (LPC, LCSW, PhD, PsyD, LMFT) has graduate-level training in psychotherapy as a condition of licensure. The label "psychotherapy" by itself doesn't tell you much — the more useful questions are about theoretical orientation, supervision background, and specialty experience. Look for clarity about how they actually work, not just what they call it.
Questions to ask
- "When you say psychotherapy, what theoretical orientation guides your work most — psychodynamic, humanistic, something else?"
- "How would you describe the structure of a typical session with you?"
- "How will we know if the therapy is working, and over what timeline?"