Key terms on this page (6)
- Theoretical orientation
- The framework a therapist uses to explain problems and guide what they do.
- Common factors
- Elements shared by effective therapies, such as the alliance, empathy and agreed goals.
- Working alliance
- The collaborative bond between client and therapist, including agreement on goals and tasks.
- Empirically supported treatment
- A specific, usually manualized therapy shown to work for a specific problem in controlled trials.
- Randomized controlled trial
- A study that assigns people at random to a treatment or a comparison, so differences can be credited to the treatment.
- Meta-analysis
- A study that statistically combines the results of many studies.
The five families
There are hundreds of named therapies, but most descend from a handful of traditions. Your theories course will cover each family’s view of how problems form and how people change. Learn the families first; the individual brands are much easier to place once you have them.
Psychodynamic
Patterns from the past, played out now
Short-term psychodynamic therapy, object relations, attachment-based approaches
Roots: Freud, then many revisions
Cognitive-behavioral
Thoughts, behaviors and what keeps a problem going
CBT, exposure therapy, behavioral activation, DBT, ACT
Roots: Beck, Ellis, behaviorism; later “third wave”
Humanistic and experiential
Present experience, emotion and meaning
Person-centered, Gestalt, existential, emotion-focused therapy
Roots: Rogers, Perls, Yalom
Systemic
Relationships and the patterns between people
Structural, strategic, Bowen, emotionally focused couples therapy
Roots: Minuchin, Haley, Bowen, Satir
Postmodern
The stories people live by, and their strengths
Narrative therapy, solution-focused brief therapy
Roots: White and Epston, de Shazer and Berg
Your license shapes your starting point. MFT programs center the systemic family, counseling programs usually survey them all, and social work adds the person in their environment. Psychology doctorates go deepest on research and on cognitive-behavioral and psychodynamic work, though programs vary.
Can you hear the difference?
Each family has an accent: the kinds of questions it asks and where it points attention. Try to hear it in these lines.
Six things a therapist might say. Which family of therapy does each one come from? Nothing is saved.
Pick an answer for each line.
What makes therapy work: the long debate
Decades of research agree that therapy helps most people who receive it. They disagree, sometimes sharply, about why. You will meet both sides in school, and both shape how clinics and insurers think.
- Specific treatments
- The technique matters
Specific therapies, tested in controlled trials for specific problems, should be the first choice. The APA’s Division 12 keeps a list of research-supported treatments and how strong the evidence is.
- Common factors
- The shared core matters
When well-delivered therapies are compared head to head, they often do about equally well, so what they share (alliance, empathy, a convincing rationale, hope) does much of the work. Bruce Wampold’s contextual model is the best-known version.
- Where many land
- Both
The relationship matters in every therapy, and specific methods matter more for some problems, such as exposure for phobias, OCD and PTSD. Choose a method that fits the problem and the person, and deliver it inside a strong alliance.
The comparison has a nickname. In 1936 Saul Rosenzweig borrowed the Dodo bird’s line from Alice in Wonderland, “everybody has won and all must have prizes,” to describe therapies performing about equally. Whether the Dodo bird verdict holds is still argued. An APA task force led by John Norcross and Michael Lambert reviewed the research on the relationship and found the alliance, empathy, collaboration, positive regard and routinely collecting client feedback to be demonstrably effective.
Evidence-based practice is a way of deciding
“Evidence-based” is often used to mean a list of approved therapies. The APA’s definition is broader, and more useful in a real session:
Best available research
What studies say works for problems like this one.
Clinical expertise
Your training, judgment and what you see in this client.
The client
Their characteristics, culture and preferences.
Evidence-based practice
How to read a study
You will be asked to read research in school, and for the rest of your career clients, supervisors and headlines will tell you what “studies show.” You don’t need to be a statistician. You need a few questions you ask every time.
- 1
Who was in it?
How many people, with what problem, from where? Results from university students may not fit your agency’s clients.
- 2
Compared with what?
A waitlist is an easy comparison to beat. Another real treatment, or usual care, is a much harder one.
- 3
Were people assigned at random?
Randomization is what lets a study say the treatment caused the change, rather than who chose it.
- 4
How big was the difference?
“Statistically significant” means unlikely to be chance, not large. Look for the effect size and what it means for a person.
- 5
Who dropped out?
If many people left one group, the people who stayed may not represent everyone who started.
- 6
Who ran it?
Studies run by a treatment’s developers tend to find larger effects. Look for independent replications.
- 7
Has it been repeated?
One study is a lead. A meta-analysis pooling many studies is stronger, though only as good as the studies in it.
How it shows up on the exams
How to get ahead
- Watch real sessions. Recorded demonstrations by the founders of each model teach the accent faster than any chapter.
- Build a one-page summary per family: view of problems, goal of therapy, therapist’s role, key techniques, founders.
- Choose one model to learn deeply in your second year, with a manual and supervision, rather than a little of everything.
- Save the methods section. When you read a study, read how it was done before you read what it found.
Three students, three orientations
Invented composites, not real people.
Lena
Counseling student
Cognitive-behavioralHer practicum site treats anxiety, and she liked having a plan for each session. She is training in exposure work and keeps a person-centered warmth underneath it.
Marcus
MFT student
SystemicHe kept noticing that the identified client was rarely the whole story. Structural family therapy gave him a map for the patterns he saw.
Ana
MSW student
IntegrativeHer clients face housing loss and trauma at once. She uses trauma-focused CBT, narrative ideas and a lot of practical help, held together by the relationship.
Myths worth dropping
Myth
“Only CBT is evidence-based.”
Actually
CBT is the most studied, but psychodynamic, humanistic, systemic and other therapies have research support too.
Myth
“The relationship is just a nice extra.”
Actually
The alliance is one of the most consistent predictors of how therapy goes, in every family.
Myth
“A significant result means a big effect.”
Actually
Significance means probably not chance. Size is a separate question, and the one clients care about.
Next · Step 9
Couples, families, children and groups
Theories become real when you meet the people you will use them with. Next: what training looks like for working with couples, families, children and groups.
Questions people ask
Do I need to pick one theoretical orientation?
Not right away, and many therapists never pick just one. Programs often ask you to write about your orientation, and it helps to be grounded in one or two families so your work is coherent. Many working clinicians describe themselves as integrative.
Is CBT the best therapy?
CBT has the most research behind it, partly because it is structured and easy to study. For many problems, other well-delivered therapies do about as well. For some, such as phobias, OCD and PTSD, specific approaches like exposure have a particularly strong record.
What are common factors in therapy?
Elements shared by all good therapies: a strong working alliance, empathy, agreement on goals, a believable explanation of the problem, a treatment that fits it, and a client who expects it can help. Research consistently links these to outcome.
What is an evidence-based practice?
The APA defines it as integrating the best available research with clinical expertise, in the context of the client’s characteristics, culture and preferences. It is a way of deciding, not a list of approved therapies.
Sources
Checked 28 October 2026. Treatment lists and exam outlines are revised over time; check the current versions.
- American Psychological Association (2006), Policy statement on evidence-based practice in psychology — Defines evidence-based practice as integrating the best available research with clinical expertise in the context of patient characteristics, culture and preferences.
- APA Division 12 (Society of Clinical Psychology), Psychological treatments — Research-supported treatments by condition, with the strength of evidence.
- APA, Clinical practice guidelines — Guidelines including the treatment of PTSD and of depression.
- Norcross and Lambert (2018), Psychotherapy — The third APA interdivisional task force on evidence-based therapy relationships and its conclusions.
- Wampold and Imel (2015), The Great Psychotherapy Debate, second edition — The contextual model and the case for common factors.
- Rosenzweig (1936), American Journal of Orthopsychiatry — The original common-factors paper and the Dodo bird quotation.
- ASPPB, EPPP content areas — Treatment and intervention 15% and research methods and statistics 7% of EPPP Part 1.
- NBCC, National Counselor Examination — Counseling skills and interventions is the largest domain of the current outline.
- AMFTRB, the national MFT examination — Domains on the practice of systemic therapy and on designing and conducting treatment.