"Just talk to someone" is useless advice

Therapy is not one product. Being told to "get therapy" is like being told to "take medicine."

For high-performing professionals in Chicago and Chicagoland: This article reflects clinical evidence and direct experience. If you're in the Chicago area or Illinois, contact me to discuss your concerns.

Nobody tells a person with a chest infection to go and take some medicine. They name the drug. But people are routinely told to get therapy, as though therapy were a single substance rather than a dozen distinct treatments with different mechanisms, different evidence bases, and different targets.

The result is predictable. People book with whoever has availability, get an approach that does not match their problem, conclude that therapy does not work for them, and do not go back for a decade.

The main approaches, and what each is actually for

Cognitive behavioural therapy

Structured, time-limited, focused on the relationship between thoughts, behaviour, and mood. Strong evidence across depression and anxiety disorders. Involves homework between sessions and is the approach most likely to feel like a course rather than a conversation.

Best fit when there are identifiable patterns of thinking and avoidance maintaining the problem.

Exposure-based therapies

A specific application within the behavioural family, and the treatment of choice for OCD, phobias, and panic disorder. It involves deliberately approaching what you have been avoiding, in a graded way, with support.

It is uncomfortable by design, and it works better than almost anything else for these conditions. Talking about a phobia does not treat it.

Dialectical behaviour therapy

Developed for people with intense emotional reactivity, difficulty regulating distress, and self-harm or interpersonal instability. Combines individual therapy with skills training in distress tolerance, emotion regulation, and interpersonal effectiveness.

Trauma-focused therapies

Including prolonged exposure, cognitive processing therapy, and EMDR. These are specific protocols for PTSD. General supportive counselling about a trauma is not the same thing and does not produce the same outcomes.

Psychodynamic therapy

Longer-term and focused on recurring relational patterns and their origins. Less structured, less homework. The fit is better for people whose difficulty is characterological or relational rather than symptom-specific.

Acceptance and commitment therapy

Focused on psychological flexibility and acting in line with values rather than on eliminating uncomfortable thoughts. Often a good fit for chronic conditions, chronic pain, and people who have found symptom-elimination approaches frustrating.

How to actually choose

Match the approach to the problem, not to whoever answered the phone.

If you have OCD, ask specifically for exposure and response prevention. If you have PTSD, ask which trauma protocol the therapist is trained in. If you have panic disorder, ask about interoceptive exposure. A competent therapist will answer these questions directly and will tell you if it is not their area.

If a therapist is vague about what they do and how it works, that is information.

The fit question

The therapeutic relationship is one of the better predictors of outcome, which means the right modality with someone you cannot work with is still a poor arrangement. Two or three sessions is usually enough to tell.

Leaving a therapist who is not a fit is normal and is not a failure. Most people who have had good therapy have also had a bad match at some point.

Published August 2026 · Reviewed for accuracy against the sources listed above.