How Therapists Decide Which Approach to Use with a Specific Client

Have you ever started looking for a therapist and noticed that they offer different types of therapy? Maybe you have heard of CBT, EMDR, psychodynamic therapy, or another approach and wondered, “How do I know which type of therapy I need?”

You may even come into therapy already believing you know the answer. A client might say, “I think I need EMDR,” or “I want to do CBT because I have anxiety.” Others may spend time online researching their symptoms and arrive with an idea of what diagnosis they have or what type of treatment they should receive.

This is actually a conversation that comes up fairly often between therapists and clients. And while it is helpful for clients to be informed and involved in their treatment, choosing a therapy approach is usually more complicated than matching a particular symptom with a particular type of therapy.

One personal example: a client came in stating they needed EMDR. When I asked why they felt this would be helpful, they said, 'I saw it when I googled treatment for trauma.' I was able to explain that EMDR is a wonderful approach to trauma treatment, but it is just one of several options. Since this was their first time in therapy and they had much to process and discuss, I suggested that talk therapy would be a great starting point before moving into the more intensive work that EMDR requires. In the end, this client was able to successfully process their trauma — and EMDR wasn't needed to explore that for this particular client.

There Isn't One Therapy That Works the Same Way for Everyone

One of the most important things to understand is that therapists generally do not choose an approach simply because a client has a certain diagnosis or symptom.

Instead, therapists consider the individual sitting in front of them.

Two people may both experience anxiety but have very different reasons for experiencing it, different histories, different coping patterns, different relationships, and different goals for therapy. What is helpful for one person may not be the right starting point for another.

As a therapist, I look at several pieces of the picture when thinking about treatment. This can include what the client is currently experiencing, what brought them to therapy, their history and previous experiences, their goals, how they process thoughts and emotions, their relationships, their ability to tolerate difficult emotions, and what they are hoping to get from therapy.

The therapeutic approach should fit the person rather than forcing the person to fit the approach.

What Does This Look Like in Therapy?

Imagine a client comes to therapy after experiencing significant anxiety following a difficult life experience. They may have read about several approaches online and believe that one specific treatment is what they need.

That information is useful. It gives the therapist an opportunity to understand what the client has learned, what they are hoping for, and what concerns them about their symptoms.

But the therapist may also discover that there are other things that need attention first.

Perhaps the client is having difficulty identifying and expressing emotions. Maybe they are struggling with negative thought patterns that are affecting their daily life. Perhaps their current environment is creating ongoing stress, or they have developed coping patterns that are keeping them stuck.

In that situation, the therapist may decide that beginning with a different approach, or combining elements of different approaches, makes more sense.

This does not mean the client's idea was wrong. It means the therapist is looking at the bigger picture.

Why Therapists May Use Different Approaches

There are many different therapeutic approaches, and each one has different ideas about how people experience difficulties and how therapy can help.

Cognitive Behavioral Therapy (CBT), for example, often focuses on the relationship between thoughts, feelings, and behaviors. It may be useful when a client wants to understand patterns of thinking and develop different ways of responding.

EMDR is an approach commonly used in trauma treatment and involves specific phases and procedures. A therapist may consider whether it is appropriate based on the client's history, current needs, treatment goals, and readiness for that type of work.

Psychodynamic approaches may focus more heavily on patterns in relationships, emotions, past experiences, and the ways those experiences may influence the present.

These are only a few examples. Therapists may also draw from other approaches or integrate techniques from multiple therapeutic models.

The important point is that the name of the therapy is only one part of the conversation. The therapist is also considering whether that approach fits this particular client at this particular point in their life.

One Common Misunderstanding: “If I Ask for a Specific Therapy, My Therapist Should Do It”

Clients should absolutely have a voice in their treatment. It is reasonable to research therapy approaches, ask questions, and tell your therapist what you are hoping to accomplish.

At the same time, therapy is not necessarily like ordering a specific service from a menu.

A client might come in saying, “I know I need EMDR,” but after talking with the therapist, they may discover that there are other concerns that should be addressed first. Another client may request CBT because they have heard it is effective for anxiety, but their therapist may find that understanding relationship patterns or unresolved experiences is also an important part of their treatment.

This is where collaboration becomes important.

A therapist should be able to explain why they are recommending a particular approach and how they believe it connects to the client's goals. The client should feel comfortable asking questions and expressing whether something feels helpful, uncomfortable, confusing, or simply not like a good fit.

Treatment is not something that should happen to a client. It should happen with them.

What If the Approach Isn't Working?

Choosing an approach is not necessarily a one-time decision.

As therapy progresses, therapists continue to learn more about their clients. A client may recognize a new goal, discover something they want to work on, or realize that a particular strategy is not helpful for them.

That information matters.

It is okay to tell your therapist, “I'm not sure this is working for me,” or “Can we talk about why we're using this approach?” Those conversations can help both the therapist and client better understand what is needed.

Sometimes the approach may be adjusted. Sometimes the therapist may incorporate different techniques. And sometimes, if the therapeutic relationship or treatment approach does not feel like the right fit, it may be appropriate to have a conversation about other options.

What Can You Do If You're Not Sure What Kind of Therapy You Need?

You do not have to figure that out before making an appointment.

One practical first step is to think about what you want help with rather than what type of therapy you think you need.

You might tell a therapist:

“I've been feeling overwhelmed and don't know how to manage it.” “I keep getting stuck in the same patterns in my relationships.” “Something from my past continues to affect me.” “I know something isn't working, but I don't know what needs to change.” “I've researched different types of therapy, but I'm not sure which one fits me.”

Those are all useful places to start.

From there, the therapist can ask questions, learn more about your experiences and goals, and work with you to determine an appropriate direction for treatment.

Therapy Should Be Individualized

One of the things I often remind clients is that therapy is not a one-size-fits-all process. There is no single approach that every person needs, even when two people appear to be experiencing similar concerns.

A good treatment plan takes the individual into account.

Your therapist's role is not simply to choose a technique and apply it. It is to understand the person sitting in front of them and consider what may be most appropriate based on that person's experiences, needs, goals, and current circumstances.

You also do not need to arrive at your first appointment knowing exactly what is wrong or what type of therapy you need. Bringing your questions and concerns to the conversation is enough.

If you are considering therapy but are unsure where to begin, that uncertainty can be part of the first conversation. A therapist can help you explore what you are experiencing, discuss possible treatment approaches, and determine together what direction makes sense for you.