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1) What Does “Evidence-Based Therapy” Actually Mean?

The phrase evidence-based therapy gets used frequently, but it doesn’t mean that one therapy has been scientifically declared the winner.

Evidence-based practice combines several pieces of information:

• The best available research
• The clinician’s training and professional expertise
• The client’s needs and clinical presentation
• The client’s values, culture, preferences, and goals
• The setting and circumstances in which treatment occurs

That distinction matters. A treatment can have strong research support for one condition and much less evidence for another. Exposure and Response Prevention, for example, has substantial support for Obsessive-Compulsive Disorder and is specifically included in treatment recommendations for OCD. Cognitive Processing Therapy, Prolonged Exposure, and EMDR have particularly strong research support as trauma-focused treatments for PTSD.

Meanwhile, approaches such as expressive therapies, Sand Tray Therapy, parts-based interventions, or integrative approaches may be used to address different clinical needs and often become part of a broader individualized treatment plan.

The takeaway? Evidence-based practice is about matching the intervention to the client, rather than finding one modality that supposedly works for everyone.

2) Guide to the Major Types of Therapy

Here’s a bird’s-eye view before we explore each approach more closely.

Therapy	Primary Focus	Commonly Used For
Cognitive Behavioral Therapy (CBT)	Thoughts, emotions, behaviors	Anxiety, depression, trauma, many other concerns
Dialectical Behavior Therapy (DBT)	Emotion regulation and behavioral skills	Emotional dysregulation, self-harm, BPD, interpersonal difficulties
Acceptance and Commitment Therapy (ACT)	Acceptance, values, psychological flexibility	Anxiety, depression, chronic stress, avoidance
Exposure Therapy / ERP	Reducing avoidance and fear responses	OCD, phobias, anxiety
Cognitive Processing Therapy (CPT)	Trauma-related beliefs	PTSD and trauma
EMDR	Processing traumatic memories	PTSD and trauma
Prolonged Exposure (PE)	Confronting trauma-related avoidance	PTSD
Motivational Interviewing (MI)	Resolving ambivalence about change	Substance use, health behavior, treatment engagement
Solution-Focused Brief Therapy (SFBT)	Goals, strengths, solutions	Short-term treatment, transitions, practical concerns
Person-Centered Therapy	Relationship, empathy, self-direction	Broad emotional and relational concerns
Narrative Therapy	Stories and identity	Identity, shame, family issues, trauma
Emotionally Focused Therapy	Attachment and emotional patterns	Couples, relationships, individual attachment concerns
Family Therapy	Relationships and family systems	Family conflict, parenting, relational concerns
Play Therapy	Developmentally appropriate expression through play	Children and families
Sand Tray Therapy	Symbolic and experiential expression	Children, adults, trauma, emotional processing
Parts Work / IFS-Informed Therapy	Internal parts and self-compassion	Trauma, internal conflict, emotional patterns
Habit Reversal Training	Awareness and replacement behaviors	Tics and body-focused repetitive behaviors
Mindfulness-Based Approaches	Awareness and nonjudgmental attention	Stress, anxiety, emotional regulation
Expressive Arts Approaches	Creative expression	Trauma, grief, children, emotional processing

And yes, therapists frequently use more than one!

1. Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is one of the most recognizable types of therapy, and for good reason. It has been studied extensively across a wide range of mental health conditions. The central idea behind CBT is straightforward: thoughts, feelings, and behaviors influence one another.

A client who thinks, “Everyone at this meeting is going to think I’m incompetent,” may feel intense anxiety. That anxiety might lead them to avoid speaking. Avoiding participation then prevents them from discovering that their fear may have been exaggerated.

CBT helps identify and interrupt cycles like this.

What Happens in CBT?

A therapist may help a client:

• Identify automatic thoughts
• Examine cognitive distortions
• Test assumptions against evidence
• Build coping strategies
• Change avoidance patterns
• Practice new behaviors
• Complete exercises between sessions

CBT can be highly structured, although skilled clinicians adapt its techniques based on the person sitting in front of them.

It is frequently used in treatment for anxiety, depression, trauma-related symptoms, insomnia, behavioral concerns, and many other conditions.

Agents of Change has additional clinical content on advanced CBT and DBT strategies as well as a broader resource on anxiety management therapies for Social Workers.

2. Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy grew from the broader cognitive-behavioral tradition but places particular emphasis on balancing two ideas:

Acceptance and change.

A client can learn to accept their current emotional experience while simultaneously working toward behavioral change. That tension is at the heart of DBT.

Full-model DBT generally includes several components, although individual clinicians may also incorporate DBT-informed skills into other forms of therapy.

Its four commonly recognized skills areas are:

1. Mindfulness
2. Emotion regulation
3. Distress tolerance
4. Interpersonal effectiveness

DBT is especially associated with treating intense emotional dysregulation, chronic suicidal behavior, self-harm, and Borderline Personality Disorder. NICE guidance, for example, recommends considering comprehensive DBT when reducing recurrent self-harm is a priority for women with Borderline Personality Disorder.

DBT skills have also spread far beyond that original population and are frequently incorporated into treatment for anxiety, depression, trauma, relationship problems, and emotional regulation challenges.

One practical example is the DBT Check the Facts skill. It teaches clients to examine whether their emotional reaction fits what is objectively occurring, separating observable facts from interpretations and assumptions.

Clinicians can explore the skill in more detail in Agents of Change’s guide to the “Check the Facts” skill with DBT.

3. Acceptance and Commitment Therapy (ACT)

What if the goal of therapy isn’t to eliminate every uncomfortable thought or feeling? That’s one of the ideas behind Acceptance and Commitment Therapy. ACT focuses heavily on psychological flexibility, meaning the ability to experience difficult internal experiences while continuing to move toward the life you value.

Rather than arguing with every negative thought, clients may practice noticing thoughts without allowing those thoughts to dictate what happens next.

Common ACT processes include:

• Acceptance
• Cognitive defusion
• Present-moment awareness
• Values identification
• Committed action
• Developing a more flexible relationship with the sense of self

Consider someone experiencing social anxiety.

A purely symptom-focused goal might be, “I need to stop feeling anxious before I attend social events.” ACT might shift that toward, “Connection matters deeply to me. Can I make room for some anxiety while still taking a step toward connection?” Subtle difference. Big clinical implication.

ACT is commonly applied to anxiety, depression, chronic pain, stress, avoidance, and other concerns.

Agents of Change’s guide to anxiety management therapies discusses ACT alongside CBT, mindfulness, and exposure-based interventions. ACT principles also appear in Process-Based Therapy, an increasingly individualized approach that targets the psychological processes maintaining a client’s difficulties.

4. Exposure Therapy and Exposure and Response Prevention

Avoidance feels helpful in the short term.

Terrified of elevators? Take the stairs.

Afraid contamination will make you sick? Wash your hands again.

Anxious about driving? Stay home.

The immediate anxiety decreases, which teaches the brain an unfortunate lesson: Avoidance worked.

Exposure-based therapies help break that learning cycle.

Instead of repeatedly escaping feared situations, sensations, memories, or thoughts, clients gradually practice approaching experiences they have learned to fear.

What Is Exposure and Response Prevention?

Exposure and Response Prevention, usually shortened to ERP, is particularly important in the treatment of OCD.

The exposure involves confronting a feared trigger.

The response prevention involves resisting the compulsion or safety behavior that usually follows.

For someone with contamination OCD, an exposure might involve touching something they consider contaminated. Response prevention could mean delaying or refraining from the ritualized handwashing that normally follows.

Over time, clients can learn that they can tolerate uncertainty and distress without performing compulsions.

ERP is one of the clearest examples of why therapists need specialized training. Reassuring a client with OCD may feel compassionate, yet repeated reassurance can accidentally become part of the client’s compulsive cycle.

Agents of Change explores related applications in its resource on supporting clients with health anxiety.

5. Cognitive Processing Therapy (CPT)

Cognitive Processing Therapy is a structured trauma-focused therapy primarily used for PTSD.

CPT examines how traumatic experiences can change what someone believes about themselves, other people, and the world.

After trauma, someone may develop beliefs such as:

• “The trauma was my fault.”
• “I can never trust anyone again.”
• “I’m permanently damaged.”
• “The world is completely unsafe.”
• “If I let my guard down, something terrible will happen.”

CPT helps clients identify and evaluate these trauma-related beliefs.

The approach addresses themes that commonly become disrupted after trauma, including safety, trust, power and control, esteem, and intimacy.

CPT is particularly well supported for PTSD. The American Psychological Association describes CPT as a specific type of CBT that helps clients challenge and modify unhelpful trauma-related beliefs.

For a much deeper explanation, read Agents of Change’s guide to Cognitive Processing Therapy (CPT).

6. Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is another structured trauma therapy.

During EMDR, the client briefly focuses on aspects of a traumatic memory while engaging in bilateral stimulation, frequently guided eye movements or another alternating sensory experience.

Treatment typically follows a structured series of phases that includes assessment, preparation, memory processing, installation of adaptive beliefs, and reevaluation.

EMDR has become particularly prominent in PTSD treatment. Current VA/DoD guidance identifies EMDR alongside CPT and Prolonged Exposure among the trauma-focused psychotherapies with the strongest evidence for PTSD.

That doesn’t mean every person with trauma automatically needs EMDR. Treatment selection should still account for preferences, symptoms, stability, clinical history, therapist competence, and informed consent.

Clinicians interested in trauma treatment can continue with Agents of Change’s broader guide to Trauma Therapy Techniques, which discusses EMDR alongside several additional approaches.

7. Prolonged Exposure Therapy

Prolonged Exposure, often called PE, is another specialized treatment for PTSD.

Trauma can cause people to avoid:

• Memories
• Conversations
• Places
• Activities
• Sensations
• People
• Situations associated with the traumatic event

Avoidance makes sense as a protective strategy. Unfortunately, persistent avoidance can also prevent new learning.

PE systematically helps clients approach safe situations and trauma memories that they have been avoiding.

Treatment commonly involves both:

In vivo exposure, which involves gradually approaching safe real-world situations that have become associated with danger.

Imaginal exposure, which involves revisiting and processing the trauma memory in a controlled therapeutic environment.

Like CPT and EMDR, PE has extensive empirical support for PTSD. The VA identifies CPT, EMDR, and PE as the trauma-focused psychotherapies with the strongest research support.

8. Motivational Interviewing (MI)

Sometimes the biggest barrier to change isn’t a lack of information.

It’s ambivalence.

“I want to stop drinking, but it’s the only thing that helps me relax.”

“I know I should take my medication, but I hate feeling dependent on it.”

“I want things to change, but I’m not sure therapy is going to help.”

Motivational Interviewing was developed for exactly these kinds of conversations.

MI is a collaborative approach that helps clients explore their own motivations for change without turning therapy into an argument.

A clinician using MI may rely heavily on:

• Open-ended questions
• Affirmations
• Reflective listening
• Summaries
• Exploring ambivalence
• Supporting autonomy
• Eliciting change talk

SAMHSA identifies Motivational Interviewing among evidence-based practices used in behavioral health treatment and continues to provide specific guidance on using MI in substance use treatment.

Two concepts are especially useful to understand.

Change talk is client language moving toward change.

Sustain talk is client language supporting the status quo.

Agents of Change has separate guides explaining Change Talk in Motivational Interviewing and Sustain Talk in Motivational Interviewing.

9. Solution-Focused Brief Therapy (SFBT)

Some therapies spend considerable time examining how a problem developed.

Solution-Focused Brief Therapy asks a different question:

What would tell us things are getting better?

SFBT is strengths-based, future-oriented, and typically focused on achievable change.

Common techniques include:

• The miracle question
• Scaling questions
• Identifying exceptions
• Exploring strengths and resources
• Recognizing previous successes
• Developing small, concrete next steps

Suppose a client says, “My anxiety is destroying everything.”

Instead of immediately analyzing every origin of the anxiety, a Solution-Focused therapist might ask, “When has anxiety been slightly less powerful this week? What was different then?”

That exception becomes information.

SFBT can be particularly useful in settings where treatment is brief, practical goals matter, or clients need to recognize resources they already possess.

Read Agents of Change’s full guide to Solution-Focused Brief Therapy for a more detailed explanation of the model and its techniques.

10. Person-Centered Therapy

Person-Centered Therapy is associated with psychologist Carl Rogers and the humanistic tradition.

Rather than positioning the therapist as the expert who tells the client what needs to change, Person-Centered Therapy places enormous importance on the therapeutic relationship.

Core principles include:

• Empathy
• Congruence or genuineness
• Unconditional positive regard
• Respect for autonomy
• Client-directed exploration

The therapist creates an environment in which clients can understand themselves, identify their own direction, and move toward growth.

Some modern therapists practice primarily from a Person-Centered orientation. Others integrate these principles into CBT, ACT, trauma therapy, family work, or nearly any other modality. In reality, techniques matter, but so does the relationship through which those techniques are delivered.

Agents of Change’s guide to commonly used Social Work tools and models explores Person-Centered Therapy alongside Narrative Therapy, SFBT, Motivational Interviewing, and other approaches.

11. Narrative Therapy

Narrative Therapy starts with an intriguing idea:

People make sense of their lives through stories.

Unfortunately, problems can begin dominating those stories.

“I’m the difficult child.”

“I’m a failure.”

“Our family is broken.”

“I’m an anxious person.”

Narrative Therapy helps clients examine, challenge, and potentially rewrite problem-saturated narratives.

One familiar technique is externalization.

Rather than “I am anxiety,” the client might begin talking about “the anxiety that keeps trying to control my decisions.”

That shift creates psychological space between the person and the problem.

Narrative therapists may explore:

• Dominant stories
• Exceptions to those stories
• Social and cultural influences
• Strengths hidden within previous experiences
• Preferred identities
• Alternative narratives

This approach can be especially meaningful when identity, power, culture, stigma, shame, family systems, or social context play major roles in the client’s experience.

Agents of Change includes Narrative Therapy in its overview of commonly used Social Work models.

12. Emotionally Focused Therapy and EFIT

Emotionally Focused Therapy is rooted in attachment theory and focuses heavily on emotional experiences and relational bonds.

It is especially well known in couples therapy, where therapists help partners recognize repetitive cycles of disconnection.

For example:

One partner feels abandoned and criticizes.

The other feels attacked and withdraws.

The withdrawal increases the first partner’s sense of abandonment.

More criticism follows.

EFT helps couples understand the underlying attachment needs driving the cycle rather than simply blaming one another for the surface behavior.

Emotionally Focused Individual Therapy, or EFIT, adapts attachment-focused principles to individual therapy.

EFIT may help clients explore:

• Emotional patterns
• Attachment wounds
• Fears of rejection or abandonment
• Difficulty trusting others
• Emotional avoidance
• Internal experiences connected with relationships

Agents of Change has a complete introduction to Emotionally Focused Individual Therapy (EFIT).

13. Family Therapy and Structural Family Therapy

Sometimes treating one person’s symptoms without understanding the larger family system misses important information.

Family therapies look at relationships, roles, communication patterns, boundaries, hierarchies, and interactions.

Rather than asking only, “What’s happening inside this person?” the clinician may also ask:

What’s happening between people?

Structural Family Therapy, associated with Salvador Minuchin, pays particular attention to the organization of the family.

The therapist may examine:

• Boundaries
• Subsystems
• Hierarchy
• Alliances
• Coalitions
• Family roles
• Repetitive interaction patterns

For example, a child’s behavior might appear to be the primary problem. A family-systems assessment could reveal inconsistent parental boundaries, parent-child triangulation, or conflict that repeatedly places the child in the middle.

That doesn’t mean the child’s behavior isn’t real. It changes the lens through which treatment is conceptualized.

Agents of Change provides a deeper guide to Structural Family Therapy as well as information about becoming a Family Therapy Counselor.

14. Play Therapy

Adults tend to communicate through conversation.

Children often communicate through play.

That distinction is central to Play Therapy.

Play Therapy uses developmentally appropriate activities and the therapeutic relationship to help children express emotions, explore experiences, build skills, and work through problems.

Depending on the approach, therapy may involve:

• Pretend play
• Puppets
• Dolls
• Games
• Art
• Storytelling
• Miniatures
• Sensory materials
• Therapeutic limit-setting
• Parent involvement

Play Therapy can be directive or nondirective.

In Child-Centered Play Therapy, for example, therapists typically follow the child’s lead while creating a safe, accepting, and carefully structured therapeutic environment.

Other play-based interventions may intentionally teach coping strategies, social skills, emotional regulation, or problem-solving.

Play Therapy can be used with children experiencing anxiety, behavioral concerns, family transitions, grief, trauma, relationship difficulties, and other concerns.

For a full overview, see Agents of Change’s guide to Play Therapy and becoming a Play Therapist.

15. Sand Tray Therapy

Sometimes words aren’t the easiest route into someone’s experience.

Sand Tray Therapy provides a visual and experiential alternative.

Clients choose miniatures and arrange them in a tray of sand, creating scenes that can represent relationships, conflicts, memories, emotions, fears, or imagined possibilities.

While people often associate Sand Tray Therapy with children, adolescents and adults can use it too.

The approach may be helpful for clients who:

• Struggle to verbalize emotions
• Think visually
• Feel overwhelmed by direct discussion
• Are processing complex experiences
• Benefit from symbolic expression
• Need some emotional distance from difficult material

A therapist might notice themes in the scene and invite the client to explore them, but careful Sand Tray work isn’t about announcing, “That dragon obviously represents your father.”

The client’s meaning matters more than the therapist’s guess.

Agents of Change has an entire guide explaining Sand Tray Therapy and how it can be incorporated into clinical work.

16. Expressive Arts Approaches

Talking isn’t the only way people process emotion.

Expressive approaches may incorporate:

• Drawing
• Painting
• Music
• Movement
• Collage
• Poetry
• Storytelling
• Drama
• Creative writing
• Visual symbolism

These methods may be especially useful when verbal processing feels inaccessible, overly intellectualized, developmentally inappropriate, or emotionally overwhelming.

Importantly, clinicians need to distinguish between incorporating expressive techniques into psychotherapy and practicing within separately regulated or credentialed professions such as Art Therapy or Music Therapy. Scope of practice, training, state regulations, and professional titles matter.

Expressive techniques can still be valuable additions to appropriately trained clinical practice.

Agents of Change discusses expressive methods, storytelling, metaphors, and other creative interventions in its guide to motivating and engaging mental health clients.

17. Internal Family Systems and Parts Work

Have you ever heard a client say something like:

“Part of me wants to leave the relationship, but another part is terrified.”

That language comes naturally to many people.

Parts-based therapy works with the idea that people can experience distinct internal states or “parts” with different roles, emotions, memories, or protective strategies.

Internal Family Systems, commonly called IFS, is one well-known parts-based model.

A client might recognize:

• A perfectionistic part
• A frightened younger part
• A highly critical part
• A people-pleasing part
• An angry protector
• A part that shuts everything down

Instead of immediately trying to eliminate a part, parts-oriented work often asks what that part is trying to accomplish.

The critical voice that sounds cruel may have developed as an attempt to prevent rejection.

The emotionally detached part may have helped someone survive overwhelming experiences.

Understanding protective intent can create room for curiosity and self-compassion.

The evidence base for IFS and parts-oriented therapies is developing, and clinicians should avoid treating every popular modality as though it has identical empirical support. That said, parts-based concepts have become increasingly common in trauma-informed and integrative clinical practice.

Agents of Change explores this approach in What Is Parts Therapy in Social Work? and discusses IFS within its broader guide to Trauma Therapy Techniques.

18. Habit Reversal Training

Habit Reversal Training, or HRT, is a much more behaviorally focused intervention.

It is commonly used for body-focused repetitive behaviors and tic-related concerns, including behaviors such as:

• Hair pulling
• Skin picking
• Nail biting
• Certain repetitive habits
• Tics

A major component of HRT involves increasing awareness of the behavior and the cues surrounding it.

Clients then learn a competing response, meaning a behavior that makes the unwanted behavior harder or impossible to perform at the same time.

Treatment may also examine environmental triggers, social support, motivation, and strategies for reducing vulnerability to the behavior.

Because HRT targets a specific behavioral cycle, it provides another good example of why “What therapy do you use?” isn’t always the best question.

A better question might be:

What treatment has evidence for the specific problem we’re trying to change?

Learn more in Agents of Change’s guide to Habit Reversal Training for Mental Health Professionals.

19. Mindfulness-Based Approaches

Mindfulness has become integrated into many therapy models.

At its core, mindfulness involves intentionally noticing present-moment experiences with greater awareness and less automatic judgment.

Clients may practice observing:

• Thoughts
• Emotions
• Physical sensations
• Urges
• Breathing
• Environmental experiences

Mindfulness doesn’t mean forcing the mind to become blank.

It also doesn’t mean accepting harmful circumstances without acting.

Instead, mindfulness can help create a little more space between an internal experience and an automatic response.

Mindfulness appears within DBT, ACT, Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, trauma-informed interventions, and many integrative approaches.

For someone whose anxiety rapidly moves from a physical sensation to catastrophic interpretation to panic, learning to notice that initial sensation without instantly reacting may become an important therapeutic skill.

20. Gestalt Therapy

Gestalt Therapy is a humanistic and experiential approach emphasizing awareness, personal responsibility, and the present moment.

Instead of focusing exclusively on explaining why something happened years ago, a Gestalt-oriented therapist might become curious about what is occurring right now.

What happens in your body as you tell that story?

What are you noticing emotionally?

What are you avoiding saying?

What changes when you imagine speaking directly to the person involved?

Experiential activities may help clients notice unresolved emotions, patterns of interaction, or discrepancies between what they say and what they experience.

Agents of Change provides a longer introduction to Gestalt Therapy.

► Learn more about the Agents of Change Continuing Education here: https://agentsofchangetraining.com

About the Lead Instructor, Dr. Meagan Mitchell: Meagan is a Licensed Clinical Social Worker and has been providing Continuing Education for Social Workers, Counselors, and Mental Health Professionals for more than 10 years. From all of this experience helping others, she created Agents of Change Continuing Education to help Social Workers, Counselors, and Mental Health Professionals stay up-to-date on the latest trends, research, and techniques.

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Disclaimer: This content has been made available for informational and educational purposes only. This content is not intended to be a substitute for professional medical or clinical advice, diagnosis, or treatment

Note: Certain images used in this post were generated with the help of artificial intelligence.