"Evidence based" is something you hear a lot about in the mental health world, often without much explanation of what it is actually pointing at. It generally does not mean a therapist is following a rigid script. It means the the overarching approach, and specific interventions have been studied, tested against alternatives, and shown to reliably help with specific difficulties. Here is what that looks like for three of the approaches I draw on in my work. An important note is that some forms of therapy lend themselves well to being studied, but this doesn't inherently mean they are more effective.
Acceptance and Commitment Therapy (ACT)
ACT takes the approach that some pain is not a problem to eliminate, it is a normal part of a full and meaningful life. Rather than focusing on getting rid of difficult thoughts and feelings, ACT focuses on changing our relationship with them. The goal is not to never feel anxious, sad, uncertain, or overwhelmed. It is to learn how to make space for those experiences while still moving toward the things that matter most to you.
A core idea in ACT is that struggling against our internal experiences can sometimes create more suffering. For example, the more we try not to feel anxious, the more time and energy anxiety can take up. ACT explores the ways we may become stuck in avoidance, whether that looks like constantly staying busy, seeking reassurance, pushing emotions away, or waiting until we feel “ready” before taking meaningful steps forward.
ACT helps build psychological flexibility, which is the ability to stay connected to the present moment, make room for difficult experiences, and choose actions that align with your values even when discomfort is present. This includes learning skills like noticing thoughts without automatically believing them, clarifying what truly matters to you, and taking small, meaningful actions toward the life you want to create.
The research backing ACT is strong, particularly for chronic pain, anxiety, depression, and situations where the goal is not simply “feel better” but “stop losing your life to avoidance.” ACT recognizes that a meaningful life will inevitably include difficult moments, and the work is not about removing those moments but building the capacity to meet them with greater openness, self compassion, and choice.
Cognitive Behavioural Therapy (CBT)
CBT works from a simple, testable idea, that thoughts, feelings, and behaviours all feed each other. Change one and the others tend to shift too. In practice, that means noticing automatic thoughts ("I always mess this up"), checking them against evidence, and experimenting with different behaviours to see what actually happens. It is one of the most heavily researched therapies that exists, particularly for anxiety and depression, and as such is often described as "the most evidence based" therapy because of this. However, it is important to note that one of the reason CBT is "the most studied" is because it's the most "easily studied". CBT doesn't always to a good job of acknowledging or working with elements of elements of life that exist outside of "evidence". Sometimes we "know" something that contradicts how we feel about something, and that doesn't necessarily mean that our felt sense is wrong or incorrect.
This sounds like a critique of CBT, and in some ways it is, but it's also important to acknowledge that CBT is part of the therapy that I offer, and I think most people offer, there are elements of it that are foundational to talk therapy, I just don't think it encompasses the whole picture.
Emotionally Focused (Individual) Therapy (EFT/EFIT)
EFT looks at distress through the lens of attachment. Seeing to understand how safe, valued, and reachable the people close to us feel, both now and throughout our early experiences, especially during moments of stress. Originally developed and studied extensively for couples, its core insight, that many relationship struggles are really expressions of deeper needs for connection and security, also extends to individual therapy through Emotionally Focused Individual Therapy (EFIT).
EFIT focuses on emotions because emotions are not viewed as problems to get rid of. They are understood as important signals that tell us something about our needs, our relationships, and our experiences. Rather than only asking “How do I stop feeling this way?” EFIT explores questions like “What is this emotion trying to tell me?” and “Where did I learn that I needed to respond this way?”
In EFIT, the goal is not to simply manage emotions or think our way out of difficult feelings. It is to slow down and develop a deeper understanding of the emotional patterns that shape how we see ourselves and connect with others. Together, therapist and client explore moments of fear, shame, anger, sadness, or loneliness to uncover the underlying needs and protective strategies beneath them.
For many people, patterns like perfectionism, people pleasing, emotional shutdown, or constantly staying busy developed for good reasons. EFIT helps create space to understand these patterns with compassion while building new ways of responding that feel more secure, connected, and aligned with who you want to be.
Relational Therapy: The Relationship Is Part of the Therapy
When we talk about evidence based therapy, we often focus on specific approaches, modalities, or techniques. But decades of psychotherapy research have shown that how therapy happens matters just as much as what happens in the room. Across different therapeutic approaches, the strength of the therapeutic relationship is consistently one of the strongest predictors of positive outcomes.
The therapeutic relationship refers to the sense of trust, collaboration, safety, and shared understanding between therapist and client. It is the feeling that you are able to show up as you are, that your experiences are understood, and that you and your therapist are working together toward something meaningful.
This does not mean that the therapist simply agrees with everything you say or that therapy is only about feeling comfortable. A strong therapeutic relationship includes honesty, curiosity, and the ability to gently challenge patterns that may no longer be serving you. It creates the foundation where difficult conversations, emotional exploration, and meaningful change can happen.
Research examining different types of therapy has repeatedly found that the therapeutic alliance is a significant predictor of outcomes, regardless of the specific modality being used. In other words, the connection between therapist and client is not just a nice addition to therapy, it is one of the active ingredients that helps therapy work.
This is why finding the right therapist fit matters. Evidence based approaches provide valuable frameworks and tools, but healing rarely happens through techniques alone. It happens through a relationship where you feel safe enough to be honest, supported enough to explore, and understood enough to begin seeing yourself differently.
None of this means therapy becomes mechanical. The research tells us these approaches work in general. Figuring out how they apply to your specific life is still very much a collaborative, human process.
Sources: https://www.ncbi.nlm.nih.gov/books/NBK470241/
https://www.tandfonline.com/doi/abs/10.1080/07351690.2021.1983399
