Therapy names are often chosen with little regard for what distinguishes the approach. The families differ in a specific way: what each treats as the source of a difficulty, which determines what actually happens in the room.
Cognitive and behavioural approaches target current patterns
These approaches locate the difficulty in present patterns of thinking and behaviour that maintain a problem, whatever originally started it.
Sessions are structured, with an agenda, specified techniques and tasks between sessions, and progress is tracked against defined targets.
The emphasis on the present is a working assumption rather than a claim that history is irrelevant, and it is what makes these approaches the most straightforward to test in trials.
Psychodynamic approaches attend to recurring relational patterns
Here the difficulty is understood partly through patterns formed earlier and repeated in current relationships, including the one with the therapist.
Sessions are less structured, and what arises in the room is treated as material rather than as a departure from an agenda.
Duration is typically longer, and the intended outcome is described in terms of understanding and changed patterns rather than symptom counts alone.
Humanistic approaches begin from the conditions for change
These approaches hold that people move toward better functioning when specific relational conditions are present, and the therapist's task is to provide them.
Sessions are led largely by the client, and the therapist's interventions aim at understanding the client's own frame rather than at introducing an external one.
The approach contributed much of the modern understanding of the therapeutic relationship, which is now incorporated well beyond its own tradition.
Systemic approaches treat the unit as larger than the individual
Family and systemic therapies locate difficulty in patterns of interaction between people rather than within one of them.
Sessions often include several family members, and the work addresses how the group operates rather than treating one person as the patient.
This is standard in child and adolescent services, where the arrangement around a young person is frequently the more accessible point of intervention.
Integration is now the common practice
Most experienced therapists draw on more than one framework, adjusting to the person and the presentation rather than applying a single model uniformly.
Some conditions do have specific well-evidenced treatments, so the choice of approach is not always open and is worth asking about directly.
The practical question for someone starting is what a session will involve and what the approach expects of them, since that difference is more consequential than the name.