Compare limitations
What does each approach tend to overlook?
Choose up to four approaches to read the limitations described in their encyclopedia entries. Follow each entry for its theoretical context, evidence, and sources.
These are editorial summaries of the approaches. They do not measure a practitioner's competence, determine referral needs, or establish treatment suitability.
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Integrative
12-Step Facilitation
Spiritual framework alienates secular clients; disease model contested; limited for co-occurring conditions
Read the full entry and its sources →Behavioral
ABA
Ethics debate about compliance vs. wellbeing; may suppress autistic self-expression; neurodiversity movement challenges core premises
Read the full entry and its sources →Trauma-Focused
Accelerated Resolution Therapy
Relatively new; mechanism not well understood; voluntary replacement raises questions about whether processing actually occurs vs. avoidance; limited independent replication
Read the full entry and its sources →Cognitive-Behavioral
Acceptance-Based Behavior Therapy
Substantial overlap with ACT makes independent identity difficult to maintain in the field; limited dissemination infrastructure compared to ACT; primarily validated for GAD rather than broad transdiagnostic application
Read the full entry and its sources →Cognitive-Behavioral
ACT
Acceptance framing can feel dismissive of legitimate suffering; metaphor-heavy approach may not land for all clients
Read the full entry and its sources →Trauma-Focused
Adaptive Disclosure
Designed specifically for military service members, so using it with a non-military client is a fit question rather than a safety concern: it is unclear how well the protocol transfers to civilian moral injury (healthcare workers, first responders); relatively new with limited replication; 12-session format may not be sufficient for complex presentations
Read the full entry and its sources →Psychoanalytic
Adlerian Therapy
Limited controlled research; birth order claims empirically weak; can feel prescriptive about lifestyle goals; teleological framing may oversimplify complex presentations
Read the full entry and its sources →Somatic
Advanced Integrative Therapy
Energy psychology framework lacks mainstream empirical support; chakra model is not validated by Western neuroscience; muscle testing has poor inter-rater reliability in controlled studies; very limited controlled research; claims about treating physical illness and cancer lack rigorous evidence; skeptical clients whose discomfort with the approach undermines the therapeutic alliance are a poor fit rather than a safety risk, a distinction that matters more here than in most modalities because the approach asks the client to accept premises the mainstream field rejects
Read the full entry and its sources →Psychoanalytic
AEDP
No controlled research; emphasis on positive affect can bypass necessary grief work; highly reliant on therapist skill
Read the full entry and its sources →Psychoanalytic
Analytical Psychology
Symbolic and mythological framework can feel esoteric; very long treatment; limited controlled research
Read the full entry and its sources →Expressive
Art Therapy
Limited controlled research; creative medium may not appeal to all clients; risk of interpretation without consent
Read the full entry and its sources →Trauma-Focused
Attachment-Focused EMDR
Limited independent research base; departure from standard EMDR fidelity raises questions for purists; requires both EMDR and attachment theory competence; some modifications not empirically validated independently; clients without developmental trauma are a fit question rather than a contraindication, since standard EMDR will usually do the job with less scaffolding
Read the full entry and its sources →Cognitive-Behavioral
Behavioral Activation
Addresses behavioral withdrawal but not underlying meaning-making, relational patterns, or trauma
Read the full entry and its sources →Cognitive-Behavioral
Behavioral Couples Therapy
May underemphasize attachment history and emotional depth; skills-based focus can feel mechanical; requires both partners' engagement; not suitable for active domestic violence situations
Read the full entry and its sources →Somatic
Bioenergetic Analysis
No controlled research; energy concepts lack empirical grounding; cathartic discharge model questioned by modern trauma theory; can overwhelm fragile clients
Read the full entry and its sources →Somatic
Biofeedback
Equipment costs limit access; resonance frequency varies by individual and requires calibration; consumer wearables not equivalent to clinical biofeedback; effects may not generalize without explicit transfer training
Read the full entry and its sources →Trauma-Focused
Brainspotting
Very limited controlled research; proposed mechanisms largely speculative; certification and consultant approval are administered by the founder's own training company with no independent accrediting body
Read the full entry and its sources →Family Systems
Brief Strategic Family Therapy
Narrow population focus (adolescents); requires family engagement; culturally specific origins may limit generalizability claims; less attention to individual intrapsychic processes
Read the full entry and its sources →Contemplative
Buddhist Psychology / Contemplative Psychotherapy
Not manualized; unclear boundaries between therapy and spiritual practice; risk of spiritual bypass; cultural appropriation concerns; non-self doctrine can be destabilizing for fragile ego structures; no controlled research as psychotherapy
Read the full entry and its sources →Crisis
CAMS
Collaboration can require adaptation when acute symptoms or cognitive difficulties limit participation. The care plan must address the person's current safety needs; emergency assessment or hospitalization may be appropriate and should not be treated as evidence that collaboration has failed.
Read the full entry and its sources →Integrative
CBASP
Narrow application (chronic depression only); pre-operational framing may pathologize; disciplined personal involvement requires high therapist skill, since the model treats it as a trained technique rather than a boundary lapse and it is not safely improvised, so the practical constraint on using CBASP is whether a trained therapist is available; limited replication outside McCullough's group
Read the full entry and its sources →Cognitive-Behavioral
CBT
May underemphasize attachment history, relational dynamics, and the therapeutic relationship itself as mechanism of change
Read the full entry and its sources →Cognitive-Behavioral
CBT-E
Transdiagnostic focus may miss disorder-specific nuance; requires client motivation which is often compromised in anorexia
Read the full entry and its sources →Cognitive-Behavioral
CBT-I
Sleep restriction can be challenging for people with bipolar disorder (may trigger mania); requires motivation and tolerance of short-term worsening; group or digital formats may not address comorbidities
Read the full entry and its sources →Cognitive-Behavioral
CBTp
Effect sizes debated when controlling for researcher allegiance; may underemphasize social determinants of psychosis
Read the full entry and its sources →Somatic
Character-Analytic Vegetotherapy
Neither of the two sources checked here establishes comparative efficacy for personality disorders. The 2025 report concerns a small nonclinical military sample and contains substantial reporting inconsistencies: different average ages in its abstract and methods, conflicting open-eyes p-values, and swapped group labels for closed-eyes percentage changes between the text and Table 4. The 2022 borderline-personality-disorder account has no comparison group or standardized outcome measures. The relationship between the 2025 intervention and character-analytic vegetotherapy, and its relevance to clinical treatment, remain unresolved.
Read the full entry and its sources →Attachment
Child-Parent Psychotherapy
Caregiver participation and service resources can limit access. Duration varies with safety needs, system involvement and trauma complexity; CEBC reports an average range of 20–32 sessions.
Read the full entry and its sources →Family Systems
Circle of Security
COS-P group protocol relies on DVD-based delivery which limits individualization; home visiting version requires significant training and supervision; not appropriate for active child abuse situations without additional safety planning; caregiver's own attachment trauma may require individual therapy beyond what COS provides
Read the full entry and its sources →Integrative
Clinical Hypnotherapy
Suggestibility varies widely; misconceptions about control create resistance; narrow evidence base beyond pain and IBS
Read the full entry and its sources →Integrative
Coherence Therapy
No RCTs; memory reconsolidation mechanism, while neuroscientifically plausible, is not clinically validated for this approach
Read the full entry and its sources →Humanistic
Collaborative Therapy
No empirical base; not-knowing stance can be misread as absence of expertise; postmodern framework not accepted by evidence-based practice advocates; may be insufficient for acute presentations
Read the full entry and its sources →Integrative
Common Factors / Contextual Model
Can be used to dismiss the value of specific training, and becomes actively harmful when invoked to justify not learning the evidence-based protocols that some conditions require; 'everything works equally' is an oversimplification; doesn't help clinicians choose what to do with a specific client; political implications (threatens modality-specific training programs)
Read the full entry and its sources →Cognitive-Behavioral
Community Reinforcement Approach
Requires significant therapist time and case coordination across life domains; CRAFT requires family member engagement; less structured than manualized CBT programs; limited training infrastructure; not suitable for acute medical withdrawal management
Read the full entry and its sources →Cognitive-Behavioral
Compassion-Focused Therapy
Compassion imagery can paradoxically increase distress in highly shame-prone individuals initially; limited outside depression/shame
Read the full entry and its sources →Cognitive-Behavioral
Compassionate Mind Training
Some clients find compassion-focused exercises aversive or triggering, especially those with attachment trauma. The evolutionary framework may feel reductive to some.
Read the full entry and its sources →Family Systems
Contextual Therapy
No empirical research base; concepts can be difficult to operationalize; requires extensive training in systemic thinking; may not be accessible for clients seeking symptom relief
Read the full entry and its sources →Behavioral
Contingency Management
Reinforcement effects may not persist after incentives end; ethical concerns about paying patients; limited to substance use
Read the full entry and its sources →Cognitive-Behavioral
CPT
Cognitive focus may underemphasize somatic and emotional processing; structured protocol can feel rigid
Read the full entry and its sources →Somatic
Craniosacral Therapy
Proposed mechanism lacks scientific validation; poor inter-rater reliability; limited evidence base; risk of clients substituting CST for evidence-based treatment
Read the full entry and its sources →Expressive
Dance/Movement Therapy
Evidence base still developing; Laban analysis requires extensive training; may not suit clients uncomfortable with body exposure; limited access outside urban centers
Read the full entry and its sources →Existential
Daseinsanalysis
Extremely small clinical community; no controlled research; philosophical sophistication can obscure clinical utility
Read the full entry and its sources →Cognitive-Behavioral
DBT
Heavy skill emphasis can feel prescriptive; may not address underlying trauma directly; requires significant client commitment
Read the full entry and its sources →Cognitive-Behavioral
DBT for Adolescents
Resource demands include individual sessions and a multi-family skills group. Developmental needs, preferences and available support can affect participation. Family or carer involvement needs individual planning; family attendance should not be presented here as a universal condition for receiving self-harm care.
Read the full entry and its sources →Trauma-Focused
Deep Brain Reorienting
One developer-involved interim trial with no active comparator and a baseline group difference on arousal symptoms; the brainstem mechanism remains a published hypothesis rather than a demonstrated pathway; no evidence yet on whether the pre-affective focus helps or hinders clients whose distress is primarily relational or meaning-based; small trained practitioner pool, with training concentrated in the UK, Europe, North America, and Australasia
Read the full entry and its sources →Family Systems
Discernment Counseling
Very brief: cannot address deep relational patterns; limited evidence base; requires specific training in managing leaning-out partner
Read the full entry and its sources →Integrative
Dual Process Model of Grief
Descriptive rather than prescriptive: tells clinicians what healthy grief looks like but less guidance on what to do when someone is stuck; cultural assumptions about individual coping may not map to collective grief practices; as with Worden, pushing a client to oscillate on cue is a misapplication rather than a contraindication, since the model describes movement, it does not prescribe it
Read the full entry and its sources →Attachment
EFT for Couples
Requires both partners to risk real emotional vulnerability; ongoing abuse is a contraindication rather than a complication, and the model is hard to run when one partner cannot tolerate the exposure it asks for
Read the full entry and its sources →Integrative
EFT Tapping
The energy explanation erodes credibility with evidence-minded clients and clinicians, and it commits practitioners to defending a claim the outcome data does not require. The method has no account of relationship, meaning, or developmental history, so it treats a distressing memory as a discrete charge to be discharged. The self-help format also puts trauma processing in the hands of people with no one else in the room.
Read the full entry and its sources →Psychoanalytic
Ego State Therapy
Very limited research; hypnotic framework may not suit all clients; potential for iatrogenic dissociation if poorly applied
Read the full entry and its sources →Psychedelic
EMBARK
Developed within a pharmaceutical research context (Cybin); limited independent replication; open-source status means variable implementation quality; requires specialized training not yet standardized across programs
Read the full entry and its sources →Trauma-Focused
EMDR
Mechanism debate unresolved; protocol fidelity varies; may be applied to conditions beyond its evidence base
Read the full entry and its sources →Integrative
Emotion Regulation Therapy
Limited evidence base (still emerging); combines many elements (complexity vs parsimony); trained therapists are scarce
Read the full entry and its sources →Humanistic
Emotion-Focused Therapy
Can be overwhelming for clients who lack basic emotion regulation; may underemphasize cognitive and behavioral dimensions
Read the full entry and its sources →Attachment
Emotionally Focused Individual Therapy
Very limited research as standalone individual model; theoretical extension from couples work not yet empirically validated; risk of dependency on therapist as attachment figure
Read the full entry and its sources →Cognitive-Behavioral
ERP
The completed assessment concerns CBT including ERP for adult OCD; it does not establish effectiveness across all anxiety presentations. Exposure without relational attunement can feel mechanical.
Read the full entry and its sources →Existential
Existential Psychotherapy
May neglect symptom stabilization and concrete coping; can feel abstract for clients in acute distress
Read the full entry and its sources →Family Systems
FBT / Maudsley
Requires parents able to supervise every meal, which assumes a household with the time and flexibility to do it; the etiology-agnostic stance can frustrate families who want to understand what happened; adolescents frequently experience the refeeding phase as coercive, a critique voiced more often in first-person accounts than in the trial literature
Read the full entry and its sources →Somatic
Feldenkrais Method
Not designed for processing psychological trauma or severe mental illness. The educational framing may be inadequate for clients who need relational psychotherapy. Limited evidence base compared to established somatic therapies.
Read the full entry and its sources →Social Justice
Feminist Therapy
Not manualized or empirically tested as standalone; political framing can alienate some clients; risk of imposing political framework; may underemphasize individual psychopathology
Read the full entry and its sources →Family Systems
FFT
Requires family engagement, so it has little to offer when the family is unavailable or is itself the source of harm; built around juvenile-justice referrals; outcomes depend heavily on therapist adherence, which makes the model fragile outside closely supervised implementations
Read the full entry and its sources →Humanistic
Filial Therapy
The tested CPRT programme required caregiver attendance and regular home play sessions. Its small volunteer adoptive-family pilot does not establish suitability for all families or the relative training difficulty of CPRT and PCIT.
Read the full entry and its sources →Trauma-Focused
Flash Technique
Extremely new; minimal independent replication; unclear when minimal-activation processing is insufficient
Read the full entry and its sources →Expressive
Focusing
Very limited controlled research; process is subtle and some clients struggle to access felt sense; can become an intellectual exercise about body awareness; not suited for acute crisis or severe disorganization
Read the full entry and its sources →Cognitive-Behavioral
Functional Analytic Psychotherapy
Requires high therapist self-awareness and willingness to use the relationship deliberately; can blur boundaries if not carefully supervised; behavioral framework may feel reductive to relationally-oriented clinicians; limited dissemination infrastructure compared to ACT and DBT
Read the full entry and its sources →Humanistic
Gestalt Therapy
Present-moment focus may miss historical context; confrontational techniques can overwhelm fragile clients
Read the full entry and its sources →Integrative
Gottman Method
Observational research base is stronger than intervention research; may underemphasize individual psychopathology and attachment injury; less suited for high-conflict or abusive relationships
Read the full entry and its sources →Somatic
Hakomi
Minimal controlled research; may be too subtle and slow for clients needing direct intervention or crisis stabilization
Read the full entry and its sources →Somatic
HeartMath
Conflates a well-supported breathing mechanism with unsupported claims about cardiac fields and heart intelligence; research base heavily self-generated; the device and score can encourage performance-oriented striving in exactly the clients who most need to stop striving; offers no framework for meaning, relationship, or trauma processing and can be mistaken for a trauma treatment when it is a regulation adjunct
Read the full entry and its sources →Psychedelic
Holotropic Breathwork
No controlled research base; contraindications are significant and screening is essential; transpersonal framework not accepted by mainstream clinical psychology; risk of retraumatization without adequate support; facilitator quality varies widely outside certified programs; not suitable for many clinical populations
Read the full entry and its sources →Cognitive-Behavioral
IBCT
Acceptance emphasis may be inappropriate when change is genuinely needed (e.g., addiction, violence); couples-only format
Read the full entry and its sources →Cognitive-Behavioral
iCBT
Dropout higher than face-to-face; may not adequately address relational or trauma dimensions; requires digital access and literacy; variable therapist involvement across programs creates inconsistency in outcomes
Read the full entry and its sources →Family Systems
IFS
Popularity far outpaces evidence base; parts language can become reified; randomized evidence is limited to one rheumatoid-arthritis trial and one group PTSD trial that did not outperform its active control
Read the full entry and its sources →Cognitive-Behavioral
Imagery Rehearsal Therapy
Requires willingness to engage with nightmare content; some find rescripting counterintuitive; not suitable during acute destabilization; limited training infrastructure
Read the full entry and its sources →Integrative
Imago Therapy
Very limited research; structured dialogue can feel mechanical; childhood wound framework may oversimplify current dynamics
Read the full entry and its sources →Humanistic
Interpersonal Process Group Therapy
Requires skilled facilitation; group composition can determine outcomes more than technique; here-and-now focus may frustrate members wanting symptom relief; less suited for acute conditions
Read the full entry and its sources →Integrative
IPNB
Framework too broad to test empirically; integration language can become vague; not a clinical method itself, and its most common misuse is neuroscience language standing in for relational engagement, since narrating a client's amygdala to them is not the same as being with them and the vocabulary is authoritative enough to make the substitution hard to notice
Read the full entry and its sources →Integrative
IPT
Focused scope (4 problem areas) may miss broader personality patterns; less suited for complex or chronic presentations
Read the full entry and its sources →Psychoanalytic
ISTDP
High confrontation can destabilize fragile clients; may underestimate the protective function of defenses in complex trauma
Read the full entry and its sources →Psychedelic
KAP
Regulatory fragmentation; limited standardization of psychotherapy component; risk of ketamine becoming the treatment rather than catalyst
Read the full entry and its sources →Integrative
Ketamine-Assisted EMDR™ (KA-EMDR)
Rests on a single uncontrolled pilot study with no comparator, run by the modality's own developers; requires the client to self-administer a Schedule III dissociative anesthetic mid-session rather than have it clinician-administered; the protocol name is trademarked and taught only through the founders' own institute, the same training-revenue structure flagged elsewhere on this site; combines two modalities, ketamine and EMDR's bilateral stimulation, whose interaction has not been independently studied, so the claimed synergy between pharmacological and psychotherapeutic mechanisms is a hypothesis, not a finding
Read the full entry and its sources →Psychoanalytic
Lacanian Psychoanalysis
Deliberately opaque; variable-length sessions can feel arbitrary; resists empirical accountability; small Anglophone community
Read the full entry and its sources →Humanistic
Life Review Therapy
Evidence base concentrated in older adult populations; younger adult applications less studied; requires therapist comfort with mortality and existential themes; can be destabilizing if significant unresolved trauma is encountered without adequate containment; not suitable for moderate-to-severe cognitive impairment
Read the full entry and its sources →Trauma-Focused
Lifespan Integration
Limited controlled research base; mechanism of action not well understood neuroscientifically; can be over-applied to presentations that need more stabilization first; rapid pace of timeline repetitions may overwhelm some dissociative clients
Read the full entry and its sources →Existential
Logotherapy
Meaning emphasis can feel premature or prescriptive; limited evidence for specific clinical populations
Read the full entry and its sources →Cognitive-Behavioral
MBCT
Primarily relapse prevention: not first-line for acute depression; requires meditation capacity some clients lack
Read the full entry and its sources →Integrative
MBSR
Mindfulness practice can be contraindicated for some trauma survivors, and adverse effects have historically gone unreported in trials; the daily home-practice demand across eight weeks selects for people with the time and stability to meet it; critics of secularization argue that lifting the practice out of its ethical framework changes what is being taught
Read the full entry and its sources →Psychedelic
MDMA-Assisted Therapy
FDA declined approval (2024); methodological concerns about unblinding; not currently legally available outside research
Read the full entry and its sources →Psychoanalytic
Mentalization-Based Tx (MBT)
Deliberately slow, and the pace can frustrate clients who came for symptom relief; offers less structure than skills-based models when a client is in acute crisis
Read the full entry and its sources →Cognitive-Behavioral
Metacognitive Therapy
Narrow focus on metacognitive beliefs may miss relational and developmental dimensions; relatively new evidence base
Read the full entry and its sources →Contemplative
Mindfulness-Based Relapse Prevention
Requires sustained meditation practice many clients find difficult; built as aftercare, so it assumes a period of stabilization rather than meeting people mid-crisis; 8-week group format may miss individual complexity; the mindfulness component has to be delivered by someone with a practice of their own, which limits how far it can be disseminated
Read the full entry and its sources →Contemplative
Morita Therapy
Culturally specific: may not translate easily outside East Asian contexts; residential format impractical in most Western settings; limited Western research; acceptance framing assumes intact capacity for purposeful action
Read the full entry and its sources →Humanistic
Motivational Enhancement Therapy
Brief format may not address underlying drivers of addiction; feedback-based approach assumes the person values health norms; cultural assumptions in normative feedback
Read the full entry and its sources →Humanistic
Motivational Interviewing
Not a standalone treatment for most conditions; because the method is strategic, its autonomy language can be used instrumentally, steering a client toward an outcome the clinician has already chosen
Read the full entry and its sources →Family Systems
MST
Extremely resource-intensive; requires 24/7 therapist availability; limited outside juvenile justice populations
Read the full entry and its sources →Integrative
Multimodal Therapy
Technical eclecticism risks superficiality: borrowing techniques without understanding their theoretical context; framework is descriptive rather than explanatory; limited controlled research
Read the full entry and its sources →Expressive
Music Therapy
Limited applicability as standalone psychotherapy; evidence strongest for specific populations (dementia, autism)
Read the full entry and its sources →Contemplative
Naikan Therapy
Potentially harmful for abuse survivors or people with excessive guilt/self-blame, as the framework asks them to focus on what trouble they caused rather than the harm they received. Must be used with clinical judgment about appropriateness.
Read the full entry and its sources →Somatic
NARM
Limited empirical evidence; five survival styles risk becoming rigid typology; developmental focus may not address acute symptom presentations; less helpful for single-incident trauma
Read the full entry and its sources →Trauma-Focused
Narrative Exposure Therapy
Designed for multiple/organized violence: may not fit single-incident civilian trauma; limited availability outside humanitarian contexts
Read the full entry and its sources →Postmodern
Narrative Therapy
Can feel intellectually abstract; political framing may not resonate with all clients; limited controlled research
Read the full entry and its sources →Somatic
Neurofeedback
High cost per session; requires specialized equipment; protocol selection is complex; limited standardization across practitioners; evidence base stronger for ADHD than trauma
Read the full entry and its sources →Integrative
NLP
Systematic reviews find no reliable evidence for NLP’s core claims. Preferred representational system theory has been repeatedly disconfirmed. Eye movement claims not supported.
Read the full entry and its sources →Postmodern
Open Dialogue
Non-randomized evidence base, and the one randomized test did not replicate it; extremely resource-intensive; challenges medical model in ways that may delay necessary pharmacological treatment; cultural specificity (Finnish context)
Read the full entry and its sources →Attachment
PACT
No controlled outcome research on PACT itself; heavy reliance on neuroscience framing may overstate what brain-based explanations can prescribe clinically; can feel confrontational when therapist tracks and names arousal patterns in real time
Read the full entry and its sources →Behavioral
PCIT
Narrow age range (2-7); requires live coaching setup; less applicable to adolescents or complex family configurations
Read the full entry and its sources →Humanistic
Person-Centered Therapy
May underemphasize skill-building, structure, and direct intervention when clients need concrete tools for acute symptoms
Read the full entry and its sources →Humanistic
Play Therapy
Evidence base is modest; age-limited; transition to verbal therapy can be poorly managed
Read the full entry and its sources →Integrative
Pluralistic Therapy
Risk of directionlessness if the therapist lacks depth in the traditions they draw from. Client preference alone may not always indicate what is clinically indicated.
Read the full entry and its sources →Somatic
Polyvagal-Informed Therapy
Underlying theory scientifically contested; clinical applications extrapolate beyond evidence; not a standalone protocol, and running it as one rather than letting it inform an evidence-based treatment is a misapplication of the framework
Read the full entry and its sources →Humanistic
Positive Psychotherapy
Limited Anglo-American evidence base and training infrastructure; name confusion with positive psychology causes misidentification; five-stage model can be applied mechanically; parable-based approach requires cultural sensitivity and may not suit all clients
Read the full entry and its sources →Somatic
Primal Therapy
No controlled trials support efficacy. Claims of neurological change lack peer-reviewed validation. Not recognized by any major psychological association.
Read the full entry and its sources →Cognitive-Behavioral
Problem-Solving Therapy
Structured skill focus can leave emotional and relational material untouched; later versions add emotion-focused coping for problems that cannot be solved, but the frame still fits situational difficulty better than grief or existential impasse
Read the full entry and its sources →Humanistic
Process Group Therapy
Can be destabilizing for clients with severe personality pathology or active psychosis. The emphasis on interpersonal feedback may be harmful without sufficient group safety and therapist skill.
Read the full entry and its sources →Cognitive-Behavioral
Prolonged Exposure
Assess practical safety, support and barriers to engagement, and adapt care accordingly. NICE NG116 recommendation 1.7.2 says drug or alcohol misuse alone should not exclude someone with PTSD from treatment. Recommendation 1.7.1 usually prioritizes PTSD treatment when depression co-occurs, but prioritizes depression when its severity prevents PTSD therapy or there is a risk of harm to self or others. Recommendation 1.7.3 calls for support with engagement barriers and attention to safety and stability. The protocol's attention to relational and meaning dimensions remains a clinical consideration, not a finding assessed here.
Read the full entry and its sources →Integrative
Prolonged Grief Disorder Treatment (PGDT/CGT)
Revisiting exercises may feel coercive for clients whose culture doesn't value explicit grief narration; the highly structured protocol may not suit every grieving style; much less evidence for non-death losses than for bereavement; 16-session format may be insufficient for losses compounded by other traumas; PGD diagnosis itself is debated as potentially pathologizing normal grief
Read the full entry and its sources →Psychedelic
Psilocybin-Assisted Therapy
Not FDA approved; challenging experiences can be destabilizing; standardization of therapy component still developing
Read the full entry and its sources →Psychedelic
PSIP
No controlled outcome research; proprietary training model without external accreditation; requires the therapist to have their own embodied practice training and is not safely improvised without it; reliance on cannabis as primary medicine complicates legal and clinical standards; apprenticeship structure creates potential dual-relationship concerns; strong theoretical claims outpace empirical evidence
Read the full entry and its sources →Psychedelic
Psychedelic Harm Reduction & Integration (PHRI)
Minimal controlled research; risk of implicitly endorsing illegal substance use; boundary challenges when clients seek substances through therapist; limited training standards; can attract clinicians with ideological rather than clinical orientation to psychedelics
Read the full entry and its sources →Psychoanalytic
Psychoanalysis
May neglect behavioral activation and symptom stabilization while pursuing insight; long timeframes can delay relief
Read the full entry and its sources →Expressive
Psychodrama
Limited controlled research; high emotional intensity can overwhelm; requires skilled direction; cathartic model questioned by modern trauma theory; group format limits confidentiality
Read the full entry and its sources →Crisis
Psychological First Aid
Not therapy: cannot address pre-existing conditions; evidence base is consensus-based rather than RCT-based; risk of being applied too broadly or replacing actual treatment
Read the full entry and its sources →Cognitive-Behavioral
Reality Therapy / Choice Theory
Oversimplifies psychopathology by rejecting diagnosis, and Glasser's later position went further, rejecting psychiatric medication and the category of mental illness itself; limited applicability to severe mental illness, trauma, and neurobiological conditions; responsibility framing can blame victims; very limited controlled research
Read the full entry and its sources →Cognitive-Behavioral
REBT
Confrontational style can rupture alliance; philosophical disputation may miss emotional and relational depth; can feel intellectualizing; less suited for trauma or severe personality disorders
Read the full entry and its sources →Psychoanalytic
Relational Psychoanalysis
No controlled research specific to relational psychoanalysis; long-term treatment raises access/cost concerns; emphasis on enactment can feel murky; risk of analyst self-disclosure serving therapist rather than patient
Read the full entry and its sources →Social Justice
Relational-Cultural Therapy
Very limited controlled research; political framing may not suit all contexts; less structured than manualized alternatives
Read the full entry and its sources →Cognitive-Behavioral
RO-DBT
Narrow application to overcontrolled presentations; may misidentify cultural reserve as pathological overcontrol
Read the full entry and its sources →Cognitive-Behavioral
Rumination-Focused CBT
Narrow focus on rumination may miss other maintaining factors. Less applicable to presentations where rumination is not a primary feature.
Read the full entry and its sources →Crisis
Safety Planning
Intervention, not treatment: does not address underlying conditions; effectiveness depends on quality of therapeutic relationship
Read the full entry and its sources →Expressive
Sandtray Therapy
Limited empirical evidence; Jungian interpretation may be imposed; requires extensive miniature collection; therapist training in symbolic interpretation varies widely
Read the full entry and its sources →Cognitive-Behavioral
Schema Therapy
Long treatment can be costly; limited reparenting may cross boundaries for some therapists; less evidence outside BPD
Read the full entry and its sources →Cognitive-Behavioral
Seeking Safety
Present-focused stabilization means trauma is never directly processed; may leave core trauma unaddressed
Read the full entry and its sources →Somatic
Sensorimotor Psychotherapy
Limited RCT evidence compared to PE or CPT; training is expensive and lengthy; body-focused work requires careful titration for highly dissociative clients; lacks the manualized structure that makes protocols teachable
Read the full entry and its sources →Postmodern
SFBT
May minimize genuine suffering by focusing prematurely on solutions; limited depth for complex trauma or personality work
Read the full entry and its sources →Psychoanalytic
Short-Term Psychodynamic
Pressure for speed may bypass clients who need longer relational repair; less suited for severe personality disorganization
Read the full entry and its sources →Somatic
Somatic Experiencing
Risk of over-physiologizing psychological meaning; limited manualization makes research difficult; can be vague in application
Read the full entry and its sources →Expressive
Sound Therapy / Therapeutic Sound
Very limited controlled research for most modalities; lacks standardized training and credentialing; theoretical mechanisms poorly understood; risk of overclaiming; easily conflated with credentialed music therapy
Read the full entry and its sources →Cognitive-Behavioral
STAIR
Two-phase structure lengthens treatment, and Phase 1 can feel slow to clients who are ready to process; the premise itself is contested, since a number of trauma researchers argue that phase-based sequencing delays effective treatment without clear evidence that a skills phase is necessary
Read the full entry and its sources →Family Systems
Strategic Family Therapy
Manipulative framing raises ethical concerns; paradoxical interventions can backfire; therapist-as-expert model; limited controlled research as standalone
Read the full entry and its sources →Trauma-Focused
Structural Dissociation
Phase-oriented approach can become indefinite stabilization that avoids processing; the model is complex and requires training specifically in dissociative disorders rather than general trauma training, and is not safe to improvise without it; presentations where a simpler trauma treatment would be sufficient are a fit question rather than a safety one; may pathologize adaptive dissociation in some cultural contexts
Read the full entry and its sources →Family Systems
Structural Family Therapy
Therapist-as-expert model can be culturally inappropriate; hierarchical assumptions may not fit all family forms; less attention to individual intrapsychic processes; limited as standalone evidence base
Read the full entry and its sources →Psychoanalytic
Supportive Psychotherapy
May maintain status quo rather than promote growth; can be used as excuse to avoid learning structured treatments
Read the full entry and its sources →Cognitive-Behavioral
TF-CBT
Built around caregiver involvement, which is hardest to arrange in exactly the cases that need it most: when the caregiver is the source of the harm, unavailable, or unwilling
Read the full entry and its sources →Attachment
Theraplay
Directive approach may not suit all families; limited evidence for older children/adolescents; requires caregiver participation
Read the full entry and its sources →Integrative
Transactional Analysis
Limited controlled research; ego state model oversimplifies; popular-psychology reputation can obscure clinical depth; script analysis can become deterministic
Read the full entry and its sources →Psychoanalytic
Transference-Focused (TFP)
Requires high distress tolerance from both client and therapist; limited applicability outside personality disorders
Read the full entry and its sources →Existential
Transpersonal Psychology
Minimal empirical base; spiritual bypass risk (using transcendence to avoid mundane psychological work); boundary confusion between psychology and religion; can pathologize or romanticize psychotic experience
Read the full entry and its sources →Somatic
Trauma-Sensitive Yoga
Certification standards vary; quality of instruction is highly variable outside certified programs; not a standalone treatment; limited RCT replication
Read the full entry and its sources →Behavioral
Triple P
Population-level approach may miss individual complexity; culturally normed parenting standards may not translate universally; the trial literature is dominated by teams affiliated with the program's developers, and independent evaluations have reported weaker effects than developer-led ones
Read the full entry and its sources →Cognitive-Behavioral
Unified Protocol
Transdiagnostic breadth may sacrifice specificity; may underperform disorder-specific treatments for some conditions
Read the full entry and its sources →Integrative
Worden's Task Model of Mourning
Task model can imply a normative sequence that doesn't match all cultural grief expressions; can pathologize grief that doesn't follow expected trajectory; limited attention to systemic and disenfranchised grief; applying the tasks as a fixed sequence is a clinician error rather than a contraindication, since the framework is not unsafe when it is forced, it is simply no longer the framework
Read the full entry and its sources →Trauma-Focused
Written Exposure Therapy
Very brief protocol may be insufficient for complex presentations; limited therapist contact compared to PE
Read the full entry and its sources →Questions for further study
Are the summaries describing theoretical assumptions, practical constraints, or limits in the research? What context would you need before comparing the claims?
For a broader comparison, compare approaches across their core ideas. For condition-specific evidence, start with the conditions directory.