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Not All Therapy Asks the Same Thing of Therapists
Apr 7, 2026
Why different therapy models ask for fundamentally different roles of the therapist.
As a supervisor of therapists for more than 40 years, one thing I repeatedly have to mention time and time again is this:
Many therapists donโt realize that they may have to take on different kinds of roles, when doing different kinds of therapy, with different patients.
The role of the therapist doing psychotherapy differs, based on the school of psychotherapy that is offered to patients. These different roles are designed based on the theoretical orientation of the treatment. Here is summary of the differing roles for therapists across some major psychotherapeutic modalities
Dialectical Behavioral Therapy (DBT)
Role: Coach
A DBT therapist assumes the role of a warm coach because this treatment is focused on behavioral change and the teaching of four behavioral skills ( Mindfulness, distress tolerance emotional regulation and interpersonal effectiveness) A DBT therapist coaches the patient to accept two contradictory principles; deep acceptance their difficulties while simultaneously coaching the patient to make behavioral change.
Cognitive Behavioral Therapy (CBT)
Role: Skills Teacher
A CBT therapist offer a patient guided collaboration, more like a teacher, in a very structured treatment. They teach cognitive skills of identifying โ hot thoughtsโ or distorted beliefs and ask patient to challenge those beliefs as a way to change their behaviors
Psychodynamic Therapist (PDP)
Role: Neutral Expert Interpreter
A PDP psychotherapist is a neutral expert interpreter and attuned observer of the patient unconscious life, feelings, thought, behaviors, and interpersonal life. They are focused on how the patientโs inner life emerges in the relationship between patient and therapist. They use interpretation of transference and countertransference to encourage insight and facilitate change.
Notice how different these roles are. You have to be human, you have to be flexible, and open to other possible ways to work with people.
In one model, the therapist is coaching for mood regulation. In the next, the therapist is actively teaching skills. In another, theyโre intentionally creating meaning.
These are not small differences. They have different intentions. For DBT & CBT the intention is to change behaviors, and for psychodynamic the intention to to bring the unconscious forward and create new understandings.
Metallization Based Therapy (MBT)
Role: A โequal-knowingโ partner
An MBT psychotherapist is a not-knowing partners who emphasizes being curious about how a patient see themselves and others. Focusing on relationship between therapist and patient, they joinlty examine how a patient mentalize, understands the feeling , thought, behaviors, and intention of themselves and others.
Scheme Therapy (ST)
Role: A โgood enoughโ parent
An ST psychotherapist assume a very relationally active role as a โgood enough parent.โ Psychotherapy is a re-parenting experience for the patient who is offered guidance, genuine caring, and validation.
Family Therapy
Role: A dual-focus โ warm with individuals, but focussed on changing the system
A family psychotherapistโs patient is the family not exclusively the individuals. The therapist works to build a warm collaborative relationships with each member of the system showing no preferences for one member over another. The therapist simultaneously is focused on the dysfunction of the family system analyzing its structure, rules, roles and communications patterns, conflicts and dysfunctional relationships. The therapistโs role is to challenge the dysfunction within the family system to improve family relationship, create productive dialogue and shared goals.
Group Therapy (GT)
Role: Warm with individuals, but letting the group facilitate change
A group psychotherapistโs patient is the group. They also have a dual focus on the feelings of individual group members and the collective process and rules that determines how the group functions. The group is the therapeutic tool as members learn from each other, get and give feedback, try our new ways to behave while finding connection with others in a in shared experience. The therapistโs guides the group norms and process to maintain safety of individuals while exploring the supportive and healing potential of the group interactions.
What I hope to instill in you is this: donโt let the dogma of a theoretical orientation exclusively determine the role that you need to take on as a therapist.
Good training, especially with good supervision, is where you learn this.
Learningโthrough supervisionโto use different therapist roles, for different patients, with varied problems is what great psychotherapy training is all about.
๐๐ปโโ๏ธInterested in developing these skills? Empathian offers training in all of these modalities and more. Follow along for upcoming programs and CE opportunities.
About the Author:
Robert E. Feinstein, MD
Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell
Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com
Owner & Founder Empathian LLC ( An Online Mental Health Education Company)ย Empathian.com
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