The reasoning
Psychotherapy is a structured, theory‑based treatment using psychological methods to modify symptoms, cognition, affect, behaviour, and relational patterns — not unstructured conversation. Change proceeds via: formulation → therapeutic relationship → identifying maintaining factors → new learning → practice → generalisation.
The common factor with the best evidence
Across modalities, the therapeutic alliance is a robust predictor of outcome (bond + agreement on goals and tasks). It is collaborative, not collusive — validation plus honest challenge.
Matching modality to problem (orientation)
- CBT — anxiety, depression, OCD (ERP), PTSD (TF‑CBT), panic (interoceptive exposure).
- Psychodynamic — recurrent relational patterns, personality, unresolved conflict.
- DBT — borderline PD, chronic self‑harm, emotion dysregulation.
- Exposure‑based — phobias, OCD, PTSD.
- Supportive — stabilisation, limited insight/capacity, acute crisis.
- Family/systemic — adolescents, eating disorders, high expressed emotion in psychosis.
Pitfalls
- Offering generic "counselling" where a specific modality has evidence (e.g., ERP for OCD).
- Neglecting alliance rupture‑repair — a common cause of dropout.
Pearls
- 🎯 Alliance is a transdiagnostic active ingredient — measure and tend it.
- 🩺 Match modality to mechanism; "therapy" is not generic.
Next → The three named therapies you must be able to deploy (Concept 48).