37% of People Don't Know What Kind of Therapy They Need. Here's How to Figure It Out.

So, you've decided you want therapy.

That decision — getting to that decision, actually making it — is not a small thing. For a lot of capable women it takes longer than it should, involves more research than it deserves, and comes with a side of guilt about not having done it sooner.

And then you start looking. And there are approximately forty-seven types of therapy, a dozen delivery formats, and enough acronyms to fill a graduate syllabus. CBT. DBT. EMDR. EFT. IFS. ACT. Weekly sessions. Intensives. In person. Online. Individual. Group.

Roughly 37% of people who want therapy report being unsure what kind of therapy would be most beneficial for them. The mental health system is genuinely confusing — and most of it is designed for providers, not for the people trying to navigate it.

This post is a plain-language guide covering some of the basics about various types and formats of therapy that can help you figure out what's right for where you are.

Start with the problem, not the modality

The most common mistake people make when looking for therapy is starting with the modality — the type of therapy — rather than the problem they're trying to address.

"What's the best therapy for anxiety?" is a less useful question than "What's driving my anxiety and what does it need?"

If your anxiety is primarily cognitive — driven by thought patterns, distorted beliefs, catastrophic thinking that you can identify and work with consciously — then approaches that work at the cognitive level, like CBT, can be very effective.

If your anxiety lives primarily in your body — in automatic physical responses that happen before thought, in nervous system patterns that don't respond to logic or insight — then approaches that work directly with the nervous system, like Brainspotting or EMDR, are likely to reach further.

If your anxiety is rooted in relational patterns — in what you learned about yourself through early relationships, in the people-pleasing and perfectionism that developed as adaptations to specific relational environments — then the therapeutic relationship itself becomes a primary mechanism of change, and the modality matters less than finding a therapist whose approach accounts for the relational roots.

Most of the women I work with need all three levels. Which is why I use both talk therapy and Brainspotting — because understanding the pattern and shifting what the body does automatically work together rather than in competition.

The question to start with isn't "what type of therapy" but "what does the problem actually need?"

Top-down vs. bottom-up approaches.

Top-down approaches work from the mind downward — they use thought, language, insight, and conscious understanding to shift experience. CBT is the clearest example. You identify a thought pattern, examine the evidence for and against it, and work to replace it with something more accurate. The change starts in the mind and works its way into feeling and behavior.

Bottom-up approaches work from the body upward — they work directly with the nervous system, the physical experience of emotion, the automatic responses that happen below the level of conscious thought. Brainspotting, EMDR, somatic therapies — these are bottom-up approaches. The change starts in the body and works its way into thought and behavior.

Neither is better. They address different levels of the same problem. And for most people with long-standing anxiety rooted in early experience, both are needed.

If you've done therapy before and gained a lot of insight without the anxiety actually shifting — if you understand your patterns very well and they keep running anyway — that's usually a sign that you've been working primarily top-down and the bottom-up piece is missing.

What the common modalities actually do

A brief, plain-language guide to what you're likely to encounter:

CBT — Cognitive Behavioral Therapy
Works with thought patterns and behaviors. Identifies distorted thinking, examines evidence, builds new cognitive habits. Useful for specific phobias, acute anxiety, depression with clear cognitive components. Less effective for anxiety rooted in nervous system patterns or early relational experience — understanding the pattern doesn't automatically change the body's response to it.

DBT — Dialectical Behavior Therapy
Originally developed for borderline personality disorder, now used more broadly. Focuses on emotional regulation, distress tolerance, interpersonal effectiveness. Useful when emotional intensity is the primary challenge. Has a strong skills-building component.

EMDR — Eye Movement Desensitization and Reprocessing
A brain-body approach that uses bilateral stimulation — typically eye movements — to help the brain process stored traumatic memories. Particularly effective for PTSD and trauma. Works at the nervous system level rather than the cognitive level.

Brainspotting
A brain-body approach that uses specific eye positions to access stored emotional and physiological experiences. Developed from EMDR but distinct in its approach. Works well for anxiety, perfectionism, burnout, and patterns rooted in early experience — particularly when understanding the pattern hasn't been enough to shift it. This is the approach I use alongside talk therapy.

Psychodynamic / relational therapy
Focuses on the relational roots of current patterns — what you learned about yourself through early relationships and how that's showing up now. The therapeutic relationship itself is a primary mechanism of change. Tends to be longer-term and less structured than CBT. Well-suited for the patterns most capable women are dealing with — perfectionism, people-pleasing, chronic self-criticism rooted in relational history.

IFS — Internal Family Systems
Works with the idea that we have multiple "parts" — different aspects of ourselves with different needs and roles. Useful for self-compassion work and for understanding internal conflict. Increasingly popular and broadly applicable.

The Question of Format

Beyond modality, there's the question of format. Weekly sessions or an intensive. In person or online. Individual or group.

For most people the relevant question is: what does my life actually support, and what does the work I need to do actually require?

Weekly therapy works well when you want consistent ongoing support, when you're working through multiple areas over time, and when your schedule can sustain a regular weekly commitment. The gradual accumulation of insight and relationship matters here. Change is integrated into the texture of ordinary life.

Therapy intensives work well when you're at a specific inflection point, when weekly therapy hasn't moved the pattern enough, when you want to go deeper faster, or when your schedule makes weekly sessions hard to protect. Extended sessions over one or two days create the time and continuity that some patterns need — particularly nervous system patterns that take time to settle into and process.

Online therapy has become the standard for a significant portion of therapy — particularly individual talk therapy and brain-body approaches like Brainspotting, which work effectively via video. The research on online therapy consistently shows outcomes equivalent to in-person for most presentations. The convenience is real and for many people removes a meaningful barrier.

How to evaluate a specific therapist

Once you have a sense of what you're looking for, the next question is whether a specific therapist is the right fit. A few things worth considering:

Do they specialize in what you're dealing with? A generalist can be excellent. But for long-standing patterns of perfectionism, people-pleasing, and burnout rooted in early experience, a therapist who works specifically with these presentations will have a more developed framework for what you're bringing.

Do they work at the level the problem needs? If your anxiety lives in your body, a therapist who works exclusively at the cognitive level may help you understand the pattern without shifting it. Ask how they work — not just what modality they use, but how they think about the relationship between insight and nervous system change.

Does the relationship feel possible? The research on therapy effectiveness consistently points to the therapeutic relationship as a significant mechanism of change — more than modality, more than technique. You need to be able to be honest with this person. That requires some basic sense of safety and fit that you'll often know within the first session.

Are they practicing sustainably? As we've written about elsewhere, therapists under significant caseload pressure have less to give in sessions. It's reasonable to ask how they structure their practice.

What if you've tried therapy before and it didn't help?

This is worth addressing directly because it's one of the most common reasons capable women delay seeking therapy again.

If therapy didn't help, the most likely explanations are: the modality didn't match the level the problem needed to be addressed at, the therapeutic relationship wasn't the right fit, the format didn't give enough time and depth for the work to take hold, or the therapy addressed the symptoms without reaching the roots.

None of those are verdicts on whether therapy can help you. They're information about what didn't work — which is useful for figuring out what might.

For women who've done a lot of talk therapy and understand their patterns very well without them shifting, the missing piece is almost always the bottom-up work. The nervous system hasn't caught up with the insight. That's a specific and addressable problem — not evidence that you're beyond help or that the pattern is permanent.

Where to start

If you've been putting off finding a therapist because the options felt overwhelming — or if you've tried therapy before and aren't sure what would be different this time — a free 15-minute consultation is a low-stakes place to start.

We'll talk about what you're dealing with, what you've tried, and whether this approach makes sense for where you are. No commitment beyond the conversation.

You've done enough research. You're allowed to take that first step.