What Are Therapy Modalities?
Welcome to my new series for therapy seekers!
Over the next several weeks, we’ll be exploring the ins and outs of therapy— I’m talking license types, therapy modalities, niches/specializations, and so much more— so that you can find the right therapist for you or your teen daughter.
Missed last week? You can check it out here.
If you’ve ever been searching for a therapist and wondered what the heck therapy modalities or orientations even are, you’re in the right place. Some therapists list a couple, some list enough to make your brain hurt. And unless you’ve been to therapy before, or happen to know a therapist personally, it’s easy to feel lost in the sea of modalities.
In today’s blog post, I break down the different therapy modalities you might come across in your online search or your social media algorithms. My hope is that, by this end of this post, you’ll feel more confident in filtering through which therapy modalities or orientations are right for you or teen daughter and which ones aren’t.
Modalities: The Framework of Therapy
If therapy is a house, the relationship between a therapist and their client is the foundation (also called rapport) and the modalities the therapist uses is the framework of the house. If the therapeutic relationship is weak or absent, the type of modalities used in therapy won’t matter because the rest of the house will come crashing down without a solid foundation. And, in a similar way, it’s not a house if you only have a foundation but no framed walls, doors, windows, or roof.
Below is a list of common therapy modalities, grouped together by how they approach treatment:
Top-Down Modalities
These orientations focus on changing the way that you think about yourself and the world:
Cognitive Behavioral Therapy (CBT): Examines the connection between thoughts, feelings, and behaviors to identify and reframe negative thought patterns (aka cognitive distortions).
Dialectical Behavior Therapy (DBT): Teaches practical skills in mindfulness, distress tolerance, emotional regulation, and social skills. Often used with self-harm and Borderline Personality Disorder (BPD).
Acceptance & Commitment Therapy (ACT): Focuses on accepting difficult thoughts and emotions without judgement while acting in a way that’s aligned with your personal values.
Exposure Therapy/Exposure & Response Prevention (ERP): Gradual exposure to feared objects, thoughts, or scenarios to desensitize triggers and break cycles of avoidance. Often used with Obsessive Compulsive Disorder (OCD).
Narrative Therapy: Separates you (the person) from your problem (e.g. anxiety) to help you challenge internalized beliefs about yourself and rewrite a more empowering personal story.
Bottom-Up Modalities
These orientations focus on improving your connection to your body and regulating your nervous system:
Somatic Experiencing (SE): Tracks physical sensations (tension, temperature, tightness) to help release trauma and stress stored in your nervous system.
Sensorimotor Psychotherapy: Focuses on how stressful memories are physically held in your body to help you heal from trauma and stress.
Brainspotting: Uses specific points in your field of vision (brainspots) to help locate, process, and release trauma, stress, and physical pain.
Relational, Experiential & Humanistic Modalities
These orientations focus on healing through your relationships with your therapist and yourself:
Client-Centered/Person-Centered Therapy: Uses empathy, unconditional positive regard, and non-directive support to allow you to guide your own growth. Founded by Carl Rogers and also called Rogerian Therapy.
Strengths-Based Therapy: Highlights your internal strengths and personal resources instead of deficits or pathologies to help you overcome challenges and build resilience.
Play Therapy: Uses games, toys, art, and storytelling to express emotions, process trauma, and learn problem-solving skills. Recommended for children and can also be helpful for young teens and those developing their verbal skills.
Equine-Assisted Psychotherapy (EAP): Uses horses, often in ground-based activities instead of riding, to build body awareness, lower stress, regulate emotions, and improve self-confidence.
Emotion-Focused Therapy (EFT): Views emotions as the primary driver of change to help you access, accept, and transform painful feelings into healthier emotional responses.
Relational Therapy: Uses your relationship with your therapist to identify unhealthy relationship patterns, resolve conflicts, and practice new ways of connecting with others.
Christian Counseling: Combines Christian faith and values with evidence-based therapeutic practices to help you cope with challenges and support your overall wellbeing (mental, spiritual, emotional, physical).
Trauma-Focused Modalities
These orientations combine top-down and bottom-up approaches to help you heal from trauma:
Psychodynamic Therapy: Explores unconscious motives, defense mechanisms, and early childhood attachment experiences to gain insight into your present behaviors and relational patterns.
Eye Movement Desensitization & Reprocessing (EMDR): Uses bilateral sensory stimulation (e.g. side-to-side eye movements) to help you process and heal from traumatic memories. Recommended for acute traumas (e.g. car crashes), but can also help with chronic traumas (e.g. childhood abuse or neglect), anxiety, and depression.
Internal Family Systems (IFS): Views the mind as a system of distinct inner "parts" (manager, firefighter, exile), each with its own perspective and role, which can be healed under the leadership of your core, compassionate “Self.”
Frequently Asked Questions about Therapy Modalities:
Are all therapy modalities evidence-based?
Some modalities, such as Cognitive Behavioral Therapy (CBT) are well-researched and proven to help reduce symptoms of anxiety, depression, stress, and more. Other modalities, such as Internal Family Systems (IFS), are still building their evidence-base, yet many have found it to be helpful in their therapeutic journey.
It’s always okay to reach out with any questions or concerns you have before starting therapy. A good therapist will be able to explain which modalities they use in their work with clients and why.
How do therapists choose their modalities?
Therapists often choose their modalities based on their personalities, therapeutic approach (e.g. direct vs. indirect), and the issues they specialize in treating. For instance, in my practice, Storied Souls Therapy, I utilize an integrative blend of several different modalities, such as Client-Centered Therapy, Narrative Therapy, Strengths-Based Therapy, and more, to tailor therapy to my client’s unique needs and preferences.
Does using my in-network insurance benefits affect which modalities my therapist uses?
Yes, it can. Insurance often requires therapists to use evidence-based modalities (e.g. CBT) and may not reimburse for some modalities, such as Equine Assisted Psychotherapy. Paying for therapy out-of-pocket (aka private pay) gives you the most flexibility in your therapeutic work, though some people choose to do a mix of in-network therapy for their primary therapist and private pay for specialists (e.g. couples therapists, Equine therapists, etc.).
How do modalities affect the therapeutic work?
Modalities or orientations are the way a therapist approaches your treatment. Typically, two therapists who utilize the same modality, such as CBT, will have a similar approach to therapy; two therapists who use different modalities, such as a therapist who uses CBT and another who uses IFS, will often differ in the way they conceptualize and treat the things you’re struggling with (e.g. anxiety, burnout, perfectionism).
Some modalities are more skills-focused and may include homework and worksheets (e.g. CBT, DBT), whereas others are more non-directive (e.g. Client-Centered Therapy, Play Therapy). However, it’s important to note that many therapists (including myself) utilize several different modalities based on a client’s needs and interests, and that can provide a different therapeutic experience than a therapist who primarily uses one modality.
Which therapy modality/modalities should I choose?
When determining which modalities are the right fit for you or your teen daughter, I recommend taking some time to reflect on what you’re looking for and what you don’t want. For instance:
Do you want a therapist who is more direct with you or indirect?
Do you want to complete homework and worksheets inside and outside of session, or does that feel too much like school work and wouldn’t be helpful for you?
Do you want a therapist who shares your faith and can integrate it into your therapy, or do you want your therapy and faith to stay separate?
Do you resonate with more of a top-down or bottom-up approach to therapy, or do you prefer a combination of the two, such as with the Trauma-Focused modalities?
Have you been to therapy before and had a positive or negative experience with a certain modality?
That’s it for today, folks! Come back next week for a breakdown of common therapeutic niches/specializations so that you can find a therapist who gets you.
And if you have any therapy-related questions that you’d like me to cover in future blog posts, you can text me at (214) 702-1785 or send me an email at hello@storiedsoulstherapy.com.
Hi, I’m so glad you’re here!
I’m Madilynn Szoboszlay, LCSW and founder/CEO of Storied Souls Therapy.
I specialize in working with high-achieving and highly sensitive (HSP) women and teen girls across Texas, Arizona, and Montana navigate anxiety, burnout, and perfectionism to feel more confident and grounded in their own skin.
Interested in working together?
Schedule a free 15-minute phone consultation with me to see if I’m the right therapist for you or your teen daughter.
Please note: This post is for educational purposes and is not a substitute for professional mental health care. Use of this site does not create a therapist-client relationship.