Evidence depends on the goal
Different therapies, different jobs
Start with the problem the person wants help with. A therapy name is not enough: ask what it targets, who delivers it and how you will know whether it helps.
CBT: thoughts, feelings and actions
Cognitive behavioral therapy (CBT) is a family of approaches that looks at relationships between thoughts, emotions and behavior. The actual treatment should be adapted to the problem being addressed; it is not simply telling someone to think positively.
For example, CBT for social anxiety may address avoidance and fear of judgment. For OCD, ask specifically about exposure and response prevention rather than assuming that general talk therapy or repeated reassurance is equivalent.
Sources: NIMH: psychotherapies (opens a new tab) · NIMH: social anxiety disorder (opens a new tab) · International OCD Foundation: exposure and response prevention (opens a new tab)
ERP: OCD-specific work
Exposure and response prevention (ERP) is a form of CBT with strong evidence for OCD. It involves facing agreed triggers while resisting compulsive responses, initially with appropriately trained guidance.
Repeatedly debating whether an intrusive thought is true can become reassurance rather than ERP. Ask about the clinician's OCD-specific experience and how family accommodation will be addressed. Caregivers should not force exposure or remove supports on their own.
Sources: International OCD Foundation: exposure and response prevention (opens a new tab) · NIMH: obsessive-compulsive disorder (opens a new tab)
ACT and DBT-informed skills
Acceptance and commitment therapy (ACT) emphasizes making room for difficult experiences while acting toward chosen values. Dialectical behavior therapy (DBT) combines acceptance and change, including emotion-regulation, distress-tolerance and interpersonal skills. A skills worksheet is not the same as a full treatment program.
Ask which approach has evidence for the specific target problem. These names should not be presented as interchangeable, a universal RSD cure, or a reason to skip OCD-specific treatment when that is indicated.
Sources: Association for Contextual Behavioral Science: ACT (opens a new tab) · NIMH: DBT and treatment for borderline personality disorder (opens a new tab)
Trauma-focused therapies
For PTSD, the VA describes evidence-based trauma-focused approaches including Cognitive Processing Therapy, Prolonged Exposure and EMDR. These involve a trained clinician and assessment of needs and readiness.
EMDR is not a general-purpose answer to every rejection fear or repetitive thought. Do not conduct trauma processing as a caregiver exercise; ask what clinical problem is being treated and how distress will be supported.
Sources: VA National Center for PTSD: treatment basics (opens a new tab)
Family work, groups and online delivery
Family or caregiver sessions can help people agree on responses and reduce conflict. Peer support can offer connection, but it is not equivalent to psychotherapy. Coaching focuses on practical goals and does not confer a clinical license.
A video appointment is a delivery format, not a therapy type. VR is also a delivery technology: ask about the actual therapeutic protocol, the evidence for its use and who supervises it.
Questions to take to a professional
Choose the questions that matter to you. Saving one does not send it to anyone.
What exact problem is this treatment targeting, and what supports that choice?
What training, license and experience do you have for this condition and age group?
How will sessions be adapted for communication, sensory and cognitive needs?
How will we judge benefit, handle setbacks, and decide when to change the plan?
Useful things to record—with permission
Keep this brief and purposeful. Notes belong in the person's private plan, not in a public discussion.
- The agreed goal and therapist's approach.
- Accessibility needs and what was agreed for practice between sessions.
- Questions, concerns, costs and practical barriers.
- Meaningful progress the person identifies, not a demand for perfect compliance.