What is the "correct" method to approaching psychotherapeutic treatment?

[u/Deep_Sugar_6467]

This is a very broad question, and I know the obvious immediate answer is that there is no definitively correct way to do it. People are different, have different issues and personalities, and therefore respond differently to varying approaches.

That said, I’m genuinely curious: is there a most legitimate or grounded method therapists use to guide treatment planning, especially when starting with a new client?

For example, to my understanding, psychiatrists often approach things through a clinical and medical lens and prioritize diagnosis and medication as a foundation. A patient might come in with symptoms of depression or anxiety, and the psychiatrist evaluates based on DSM criteria, then prescribes SSRIs or other medication as a first step in treatment.

In contrast, clinical psychologists (especially those trained in CBT) might focus on thought patterns, behavior tracking, and goal setting. They may zero in on distortions and coping mechanisms, offering structured interventions based on cognitive-behavioral models.

Psychoanalysts, from what I understand, take a very different route by diving into unconscious motivations, early childhood experiences, and deep patterns over long stretches of time. It’s more exploratory and interpretive than action-based.

The list continues on with various other therapies like humanistic therapy or other modalities like EMDR or somatic therapy.

Even now, I'm in therapy with a Christian therapist, and the things I hear are obviously very different and specific than a secular therapy program. Granted, this decision was of course deliberate, so I have the ability to appreciate and utilize what I hear because it falls in line with my personal beliefs. But, coming into it with a lot of what seems like depression and obvious anxiety, I feel like if I theoretically took my issues to a psychiatrist, I could get some sort of diagnosis within the first couple of sessions. On the contrary, with my current therapist (whom I do thoroughly like), I don't see a diagnosis coming anywhere down the line. That's not to say I want one, but it does make me wonder how different kinds of therapists view these things, like disorders, and their objectivity/concreteness.

So I guess my question is: Is there any consensus on what the most grounded or widely respected framework is for approaching psychotherapy in a general sense? Or is the answer always going to be “it depends”? Are there approaches that are more evidence-based across populations or conditions? I’m not looking to discredit any modality—just hoping to better understand the logic behind how therapists choose a direction, especially early on with a new client.

Would love to hear how professionals (or those in training) think about this. Thank you.

[u/jiffypop87]

No. You already answered your own question. The logic of which direction a therapist takes is dependent upon: (1) their training background. There are so many approaches, and rarely does a therapist get exposure or mastery in more than a handful. We are products of our past teachers and supervisors. (2) Case conceptualization. Usually the first step after an intake/clinical interview with a new client is to think about their presenting problem, the factors reinforcing it, and the things that need to be done to change the pattern to meet their goals. This is where the clinician should be tailored to the specific client needs. A client with BPD will need a different approach from a client with OCD (or chronic pain, or insomnia, etc). But again, the way to create a case conceptualization is limited by past training experiences. (3) Personal style. Certain approaches resonate more with the therapist themselves, or they have found beneficial for themselves in the past. (4) Approaches can change. Sometimes when working with a client, I realize after a few months that the current approach isn’t working. If I have an idea of how to switch it up effectively then I will (with their consent). If I don’t, I’ll refer to someone else.

That said, there are larger bodies of research supporting certain approaches over others. Like if a client has insomnia without sleep apnea then you should 100% do CBT-I before prescribing medications. But in general there is no “one therapy to rule them all.”

ETA: you mentioned diagnosis. This is another area of contention, but again depends on the client’s goals. If a client wants a diagnosis and 6-month treatment plan to reduce symptoms then the process should be tailored to that. If the client just wants a sounding board and deep exploration without a “label” or time limit, then that should be the approach the therapist takes.

[u/Deep_Sugar_6467 → u/jiffypop87]

Thank you for this detailed response! This all makes a lot of sense :)

In regard to diagnoses, I'm curious, are there instances where it would be counterproductive to diagnose someone, even if it were an accurate assessment? This is a random example, but let's take someone who wants a diagnosis for the sake of confirming they have something wrong with them. There's a chance giving that diagnosis would make them less receptive to treatment based on their thought that they are boxed into a certain labeling, even though that's seemingly what they "want" to know/hear. In this case, is it okay to withhold a possible diagnosis from them for the sake of continuing treatment at the proper pace? I suppose in that way, you're seeing them more as a "patient" and less of a "client" by acting on behalf of their own good rather than complying with their goals.

That's purely theoretical, and it could be a terrible example, but I do feel like I meet people who have the mentality that they are "diagnosed with ______, therefore that's who I am and I just gotta deal with it, there's no fixing me." That kind of mentality seems like it is not conducive to being receptive to psychotherapeutic treatment.

I want to clarify with my example that I am referring to less severe diagnoses. Of course, if someone is bipolar or genuinely requires some kind of antipsychotic medication, that's important to know and shouldn't be withheld at all.

Again, forgive me if this is a stupid example hahaha, I'm not an expert by any means. I'm just curious

[u/book_of_black_dreams → u/jiffypop87]

I saw this awful psychodynamic therapist as a pre-teen/teenager who believed that all diagnostic labels were evil and refused to tell anyone what their diagnosis was. Not surprisingly, he also committed a ton of ethical violations - including not reporting abuse of a minor, seeing multiple members of the same family for individual therapy, putting me in sessions with my abuser, etc.

[u/TEForce]

You’re absolutely right that it depends 😅 it’ll depend on the therapists therapeutic approach, what the client is initially coming in for, the setting that you’re in (different agencies/clinics/hospitals might have specific intake forms), and what you start to suss out as you’re doing the initial intake. For me I have a mix of basic specific questions: Suicidality and homicidality, substance use, frequency of presenting concern, intensity of presenting concern, history of therapy, etc; essentially things that you can ask on a form but might go through to confirm things /get more info. Im ACT informed so I’ll do the ACT matrix too, and I’ll often incorporate more person-centered and cultural questions too: patient strengths, social supports, culture/cultural implications. I also want to give them time to just talk, usually with the questions “why therapy and why now?”.

Like I said it’ll depend, I’ve been in places where I had a lot of freedom in how I did the intake, places where it was a very specific intake process, and some in between. The process may be shorter or longer depending on the person. My process may look very different than others but ultimately I want the person in front of me to feel heard, understood, and respected. It’s a collaborative process and they’re the expert on their experience so we try to adapt with them as we can.