Different problems respond to different tools. I don’t use a single modality with everyone because that would mean fitting people to a method rather than finding the method that fits the person. Here’s how I think about and apply each approach in practice.
CBT is built on a straightforward observation: the way we interpret events shapes how we feel and behave, and those interpretations aren’t always accurate. Most people have a handful of recurring thought patterns (catastrophizing, mind-reading, all-or-nothing thinking) that drive a disproportionate share of their distress.
In practice, CBT work isn’t really about replacing negative thoughts with positive ones. It’s about demanding evidence. When a thought shows up, like “I’m going to fail,” or “nobody actually wants me around,” or “this is never going to get better”, the clinical move is to examine it like a hypothesis rather than a fact. What’s the actual evidence? What would you say to a close friend who thought the same thing? Over time, this builds a more accurate and flexible internal narrator.
DBT was originally developed for people with borderline personality disorder, but its core skill set (distress tolerance, emotional regulation, interpersonal effectiveness, and mindfulness) is genuinely useful for anyone who experiences emotions intensely or feels like they lose themselves in conflict.
The “dialectical” in DBT refers to holding two things at once: you are doing the best you can, and you need to change. That tension doesn’t resolve into one being more true than the other. Both stay true at the same time, and learning to hold them without collapsing into either one is the engine of the work. I use DBT-informed approaches rather than a rigid full-protocol DBT in most cases, pulling the skills that are most relevant to what a given client is navigating. For clients with personality disorders or significant emotional dysregulation, it’s often the most efficient framework available.
IFS operates on the premise that the mind is not a monolith, but is instead made up of distinct parts, each with its own history, agenda, and emotional logic. The part of you that self-sabotages isn’t broken; it’s trying to protect something. The part that rages at people you love isn’t irrational; it learned that behavior because it worked at some point.
IFS gives us a language and a framework for working with those parts rather than against them. Instead of fighting the anxiety or the self-criticism, we get curious about what it’s protecting and what it needs. The goal is to return leadership to what IFS calls the Self, which is the core of you that can hold all the other parts without being overwhelmed by any of them. I find IFS particularly useful when someone has tried to “logic their way out” of a pattern that keeps reasserting itself despite understanding exactly what it is.
The story you tell about yourself shapes what you think is possible. Narrative therapy works with the idea that problems are separate from people; you are not your depression, your addiction, or your past. These are things that have influenced your story, but they don’t have to define its direction.
In practice, this often means identifying the dominant narrative someone has been living inside, like “I’m fundamentally broken,” or “I ruin everything I touch,” or “I don’t deserve good things” and finding the exceptions, the moments and evidence that don’t fit the story. Those exceptions become the foundation of an alternative narrative that’s more accurate and more livable. Narrative work is particularly powerful for identity-level change and is useful to clients who aren’t just trying to feel better, but to fundamentally understand themselves differently.
MI is a collaborative approach to ambivalence. Most people who come to therapy aren’t fully committed to change. Part of them wants things to be different, and another part has very good reasons for keeping things exactly as they are. MI works by making space for that ambivalence rather than arguing against it.
The underlying principle is that people change when they hear themselves articulate their own reasons for doing so, not when a therapist tells them what those reasons should be. My job in MI mode is to ask questions that draw out the client’s own motivation, reflect their own language back to them, and create conditions where the case for change comes from the inside rather than being imposed from the outside. This is particularly central to addiction work, but I use MI elements in almost every case where there’s any degree of ambivalence about the work itself.
Carl Rogers’ premise was that people have an innate tendency toward growth and self-actualization, and that the primary thing standing in the way is the absence of certain relational conditions like unconditional positive regard, empathy, and genuineness. When those conditions are present, people tend to move toward health on their own.
I don’t use person-centered therapy as a discrete intervention so much as a foundational posture. The way I listen, the absence of judgment, the genuine interest in who someone is rather than just what’s wrong with them is Rogerian in its roots. Every effective therapeutic relationship is built on these conditions whether or not a clinician names them. For clients who have spent their lives feeling fundamentally unseen or misunderstood, the experience of simply being heard without an agenda can itself be the most therapeutic thing that happens in the room.
Existential therapy takes seriously the questions that don’t have clean answers: “What am I supposed to do with my life?” “How do I live with the fact that everything ends?” “What does it mean that I’m free to choose and also completely responsible for those choices?” These are often the source of the anxiety, the depression, or the paralysis that brings someone to therapy.
I use existential thinking when someone is dealing with questions of meaning, freedom, isolation, and mortality. This comes up frequently in grief, major life transitions, and in clients who have processed the mechanics of their problems but still feel like something fundamental is unresolved. Existential work isn’t about finding answers; it’s about developing the capacity to live fully in the presence of questions that can’t be resolved.