CBT, DBT, ACT, psychodynamic: a plain glossary of therapy names

The names of the psychotherapies are not brands and not rankings. They are family names: each one says where a method came from and what it treats as the lever of change — thoughts, unconscious patterns, relationships, or the relationship between a person and their own experience. This article defines the names. It does not recommend one, which is a conversation for a qualified clinician.

• CBT, DBT, ACT and schema therapy belong to one family. They share a behavioural ancestry and disagree about what to do with unwanted thoughts.
• Psychoanalysis and psychodynamic therapy are the same tradition at different intensities, not two different theories.
• Systemic therapy locates the problem in a system of relationships rather than in one person, which is why it often involves more than one person in the room.
• The names describe a method, not a level of qualification. Who is allowed to practise is set by law and differs by country.
• In Germany the names are also legal categories: statutory insurance reimburses four defined procedures and nothing else.

Why the names are confusing

Because three different naming systems have been laid on top of each other. Some names describe a theory of change — cognitive, behavioural, systemic. Some are the name of a manualised programme with an inventor and a training institute — DBT, ACT, schema therapy. And some are administrative categories invented by a health system to decide what it will pay for.

A single method can sit in all three at once. That is why a leaflet can list six therapies as though they were parallel options when two are families, three are programmes inside one of those families, and one is a billing category.

The useful question is not which is best. It is which lever a method pulls, and each family answers that differently.

The cognitive and behavioural family

Behaviour therapy came first, out of learning research in the 1950s, and treated behaviour itself as the target. Cognitive therapy arrived in the 1960s and added the content of thought. The merger is what most people mean by CBT.

CBT

Cognitive behavioural therapy works on the loop between thoughts, feelings and behaviour: identify the automatic thought, test it against evidence, change what follows from it. Aaron Beck built the depression protocol, published as a manual with Rush, Shaw and Emery in 1979; Albert Ellis had arrived at a related approach a decade earlier and called it rational emotive behaviour therapy. CBT is structured, time-limited and homework-heavy by design.

DBT

Dialectical behaviour therapy was developed by Marsha Linehan and published in 1993, originally for chronically suicidal patients and subsequently associated with borderline personality disorder. Its dialectic is between change and acceptance — the insistence that a person is doing the best they can and needs to do better simultaneously. Standard DBT is a package rather than a conversation: individual therapy, a skills group covering mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, and telephone coaching between sessions.

ACT

Acceptance and commitment therapy, said as the word act rather than as three letters, was set out by Steven Hayes, Kirk Strosahl and Kelly Wilson in 1999. It does not try to change the content of thoughts. The target is psychological flexibility: reducing entanglement with thoughts, accepting unwanted internal experience, and acting on stated values anyway. Hayes described it in 2004 as part of a third wave of behavioural and cognitive therapies, alongside DBT and mindfulness-based approaches.

Schema therapy

Jeffrey Young’s schema therapy, published in 1990, was built for problems that did not respond to standard CBT. It keeps the cognitive machinery and adds early maladaptive schemas — enduring patterns formed when childhood needs went unmet — and modes, the states a person shifts between. It is the most integrative member of the family, borrowing openly from attachment theory and psychodynamic work.

The psychodynamic family

Psychoanalysis, psychodynamic therapy and depth-oriented therapy are one tradition at different intensities. They share the premise that patterns outside awareness shape present difficulty, and that the relationship with the therapist is where those patterns become visible.

The differences are practical rather than doctrinal. Classical psychoanalysis means high frequency over years. Psychodynamic therapy usually means once a week, sitting up, over months to a couple of years, with a more defined focus.

Jonathan Shedler set out seven features that distinguish the family in practice: a focus on affect and its expression, attention to attempts to avoid distressing material, the identification of recurring themes, discussion of past experience, a focus on interpersonal relationships, attention to the therapy relationship itself, and exploration of wishes and fantasy. Any therapy with most of those features is psychodynamic whatever it calls itself.

The systemic family

Systemic therapy takes the problem out of the individual and puts it in the pattern of relationships around them. Its origins are in family therapy in the 1950s and 1960s — Gregory Bateson’s group in Palo Alto, Salvador Minuchin’s structural approach, and the Milan team around Mara Selvini Palazzoli.

The consequence is procedural: sessions may include partners, parents or whole families, and the questions are circular rather than causal — who noticed first, what happens next, who reacts to whom. Solution-focused brief therapy, developed by Steve de Shazer and Insoo Kim Berg in the 1980s, comes out of this tradition and cuts it down to what is already working.

The humanistic family

Carl Rogers set out the fourth major tradition, in which the relationship itself is the treatment rather than the vehicle for it. His 1957 paper on the necessary and sufficient conditions argued that genuineness, unconditional positive regard and accurate empathy are what produce change, and that specific techniques matter less than most schools assume. Person-centred, client-centred and Gesprächspsychotherapie all name this approach; whether it is reimbursed varies sharply by country.

The names in one table

Where the names become legal categories

In several countries the words above are not only descriptions. In Germany, statutory health insurance pays for a defined set of procedures, and a method outside that set is not reimbursed however well evidenced it is.

The Federal Joint Committee’s psychotherapy directive names those procedures. Analytic psychotherapy, depth-psychologically founded psychotherapy and behaviour therapy have been in it for decades; systemic therapy for adults was added by a decision of 22 November 2019, reimbursable from mid-2020, and extended to children and adolescents in January 2024. EMDR sits in the directive as a method usable inside those procedures for post-traumatic stress disorder in adults, added in 2014, rather than as a procedure of its own.

That is a different question from the one an English-speaking reader usually asks, and it is why the German version of this article is not a translation of it. It also explains a recurring confusion for international students in Germany: the professional titles and the procedures are regulated separately, and knowing one tells you little about the other.

What this article is not

It is not a recommendation. Nothing here says which approach suits which person or which difficulty, because that depends on the difficulty, the person, the evidence base for that specific combination, and what is available where you live — and because deciding it is clinical work.

Two things are worth saying plainly, though. A name is not a qualification: the law decides who may treat, and it differs by country. And the words above describe methods, not severity — nobody is too mild for one or too serious for another purely on the strength of a label.

If you are trying to decode a referral letter or a directory listing, the vocabulary in this article is the part you can settle on your own. The rest belongs in a conversation with a qualified professional. The terms here also sit next to two other clusters worth having straight: what burnout is and is not, and the English and German names for the same methods, which diverge more than you would expect. Learning a set of near-identical labels is a job a deliberate method makes much easier.