PSYC4089 Exam Notes and Study Guide: Critical Analysis of Psychotherapeutic Interventions at Wits University

Critical analysis of psychotherapeutic interventions requires more than remembering therapy names or listing techniques. It demands an understanding of how interventions are justified, what evidence supports them, where they work best, where they fail, and how they are shaped by culture, ethics, training, and systems of care. This study guide is written for students preparing for advanced clinical and abnormal psychology work at Wits University, with a strong focus on comparison, evaluation, and exam-ready analysis.

1. Foundations of Critical Analysis in Psychotherapy

Critical analysis begins with a simple but demanding question: why should this intervention work, for whom, under what conditions, and at what cost? In psychotherapeutic practice, the answer is rarely absolute. Most interventions are helpful for some clients in some contexts, but the quality of evidence, the fit with the client, and the competence of the therapist all influence outcome. A strong PSYC4089 answer does not merely describe a therapy; it evaluates the logic of the therapy, the strength of the research, the ethical issues involved, and the clinical realities that shape implementation.

What “critical analysis” means in psychotherapy

Critical analysis is not the same as criticism in the everyday sense. It is a structured evaluation based on evidence and theory. In exam writing, this means:

• identifying the assumptions behind a therapeutic model,
• assessing empirical support,
• comparing alternatives,
• considering limitations and contraindications,
• and linking theory to real clinical practice.

A purely descriptive answer might say that cognitive behavioural therapy, or CBT, helps clients challenge negative thoughts. A critical answer asks whether the evidence shows CBT is superior to other treatments, whether its methods are equally effective across cultures, whether it addresses social causes of distress, and whether symptom reduction is the best outcome to value.

The major dimensions of evaluation

A useful framework for analysis is to examine psychotherapy across several dimensions:

1. Theoretical coherence
   Does the therapy have a clear explanation of psychological distress? For example, CBT assumes thoughts, emotions, and behaviours interact reciprocally. Psychodynamic therapy assumes unconscious conflicts and early relational patterns shape present functioning. Humanistic approaches emphasise self-actualisation and congruence.

2. Empirical support
   Is there evidence from randomised controlled trials, meta-analyses, and naturalistic studies? Are results consistent across populations and settings?

3. Clinical utility
   Even if evidence is strong, is the intervention practical in real-world settings? Is it time-efficient, affordable, and deliverable by available clinicians?

4. Client fit and person-centredness
   Does the therapy align with the client’s needs, preferences, developmental stage, language, and culture? A well-supported intervention can still be ineffective if it is poorly matched to the client.

5. Ethical and social context
   Does the therapy respect autonomy, avoid harm, and account for structural factors such as poverty, gender-based violence, racism, or disability?

6. Mechanisms of change
   What is actually causing improvement: specific techniques, therapeutic alliance, expectation, behavioural activation, exposure, or common factors? This question matters because some therapies may be effective for reasons different from those claimed by their founders.

The evidence hierarchy and its limits

In psychotherapy research, randomised controlled trials are often treated as the strongest evidence because they reduce confounding variables. Meta-analyses then combine many studies to estimate overall effects. However, critical analysis must recognise the limits of this hierarchy.

RCTs can be highly controlled and therefore less representative of actual clinical work. They may exclude clients with comorbidities, suicide risk, substance use, or unstable living conditions—yet these are common in practice. A therapy that performs well under research conditions may be harder to implement in a community clinic with high caseloads, limited supervision, and cultural diversity.

There is also the issue of allegiance effects. Therapists and researchers who strongly believe in a treatment may obtain better results, not only because the therapy is effective but because motivation, fidelity, and expectation are higher. This does not invalidate the evidence, but it complicates interpretation.

Common factors versus specific factors

A major debate in psychotherapy concerns whether improvement comes mainly from common factors or specific techniques.

• Common factors include the therapeutic alliance, empathy, hope, warmth, and client expectancy.
• Specific factors include interventions unique to a model, such as exposure in anxiety treatment or interpretation in psychodynamic therapy.

A critical position is not to choose one side too quickly. The alliance clearly matters, but not all therapies are equivalent in specific outcomes. For example, exposure-based procedures are especially important in anxiety disorders because avoidance maintains fear. Similarly, behavioural activation can be crucial in depression because inactivity and withdrawal perpetuate low mood. The best exam answers show that common factors create the conditions for change, while specific factors may determine the direction and speed of change.

A concise comparison of major evaluation lenses

Evaluation lens	Key question	Example of strong analysis
Theoretical coherence	Does the theory explain symptoms plausibly?	CBT links automatic thoughts to emotion and behaviour in a testable way.
Empirical support	Does research support the therapy?	Exposure has strong evidence for phobias and panic.
Practical utility	Can it be delivered in real settings?	Brief CBT may fit primary care better than long-term therapy.
Cultural fit	Does it align with client context?	A therapy that individualises distress may overlook social adversity.
Ethical soundness	Does it minimise harm and respect autonomy?	Forced disclosure in trauma work may be harmful if poorly timed.

How to write critically in an exam

An excellent PSYC4089 answer often follows this pattern:

• define the intervention,
• identify its theoretical foundation,
• evaluate evidence,
• discuss strengths and limitations,
• consider client and contextual factors,
• conclude with a balanced judgement.

A balanced judgement is not weak. It is intellectually stronger than claiming that one therapy is simply “best.” Psychotherapeutic interventions are best understood as tools with differential usefulness rather than universal cures.

2. Major Psychotherapeutic Approaches and Their Comparative Strengths

Psychotherapeutic interventions differ in assumptions about distress, therapeutic goals, and methods of change. For critical analysis, the key is not memorising isolated features, but comparing approaches on what they explain well and what they may overlook. The main traditions encountered in abnormal psychology include CBT, psychodynamic therapy, humanistic therapy, systemic and family approaches, and newer integrative or third-wave interventions.

Cognitive behavioural therapy

CBT is one of the most widely researched interventions. It assumes that maladaptive thoughts contribute to emotional distress and that behaviour patterns can maintain or reduce symptoms. CBT includes cognitive restructuring, behavioural activation, exposure, problem-solving, and skills training.

Strengths:

• strong evidence base for depression, anxiety disorders, PTSD, panic disorder, obsessive-compulsive disorder, and some insomnia presentations,
• structured and time-limited, which suits many public-sector and university settings,
• relatively easy to manualise and evaluate,
• helps clients develop practical coping skills.

Limitations:

• may be too symptom-focused when distress is deeply relational, existential, or trauma-related,
• can appear overly rational or individualistic if contextual adversity is ignored,
• requires cognitive engagement that may be difficult in acute crisis, severe cognitive impairment, or high emotional dysregulation,
• quality depends heavily on therapist skill and adherence.

A critical perspective on CBT recognises that it is not one single therapy. A therapist who merely challenges thoughts superficially without addressing avoidance, safety behaviours, or emotional learning is not delivering effective CBT. In anxiety disorders, exposure is often the active ingredient; in depression, behavioural activation can be especially powerful. Therefore, an exam answer should avoid treating CBT as only “changing negative thinking.”

Psychodynamic therapy

Psychodynamic therapy emphasises unconscious processes, defence mechanisms, internal conflict, attachment patterns, and the influence of early relationships. It can be brief or long-term, supportive or exploratory.

Strengths:

• useful for complex, chronic, and relational difficulties,
• attends to meaning, identity, and repeated interpersonal patterns,
• encourages insight into defences and unconscious conflict,
• may be particularly relevant where symptoms reflect longstanding personality organization or unresolved trauma.

Limitations:

• historically criticised for weaker standardisation and fewer high-quality trials compared with CBT,
• interpretation can be subjective and difficult to operationalise,
• long-term treatment may be resource-intensive,
• outcomes may be harder to measure using symptom scales alone.

Critical analysis should not dismiss psychodynamic therapy simply because some of its concepts are less easily quantified. Relationship patterns, transference, and affect regulation are clinically meaningful even if not always captured by narrow symptom measures. However, a strong answer also notes that some psychodynamic claims have been overstated historically and require careful empirical support.

Humanistic and person-centred therapy

Humanistic therapy places emphasis on empathy, unconditional positive regard, congruence, and the client’s capacity for growth. Person-centred therapy is especially associated with Carl Rogers.

Strengths:

• provides a deeply respectful and non-pathologising approach,
• supports alliance building and client autonomy,
• useful where clients feel judged, marginalised, or disempowered,
• complements other therapies because relational safety is essential.

Limitations:

• may be less structured for severe disorders requiring active symptom reduction,
• can be too nondirective for clients who need practical coping strategies,
• evidence base is often less disorder-specific than CBT,
• may underplay the role of diagnosis, risk management, and behavioural change.

A sophisticated evaluation sees humanistic therapy as foundational rather than competing with all other interventions. The empathic stance is not merely “soft”; it may be a mechanism through which clients can explore distress without shame. Yet in a high-risk context, empathy alone is insufficient.

Systemic and family therapies

Systemic approaches conceptualise symptoms within relationship patterns, communication styles, and broader family or social systems. They are particularly relevant in child and adolescent work, couples therapy, substance use, and relational conflict.

Strengths:

• addresses contextual and interpersonal maintenance factors,
• avoids locating all pathology within the individual,
• useful where family dynamics contribute to distress,
• can improve communication and support networks.

Limitations:

• family involvement is not always possible or safe,
• conflict, abuse, and secrecy may complicate intervention,
• requires skill in managing multiple perspectives,
• may overlook intrapsychic suffering if too system-focused.

Critical analysis should note that systemic work is often particularly valuable in contexts like South Africa, where family structures may be shaped by migration, economic pressure, intergenerational caregiving, and community stress. A rigidly individual approach may miss these realities.

Third-wave and integrative interventions

Third-wave therapies include Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, mindfulness-based therapies, and compassion-focused approaches. These therapies often focus less on changing content of thoughts and more on changing the relationship to thoughts and emotions.

Strengths:

• useful for emotion regulation, chronic distress, and repetitive patterns,
• often integrate acceptance with behaviour change,
• may fit clients who do not benefit from purely disputational techniques,
• increasingly supported for specific conditions such as borderline personality disorder, chronic anxiety, and recurrent depression.

Limitations:

• some concepts are marketed broadly despite uneven evidence,
• mindfulness interventions are sometimes delivered superficially,
• cultural interpretation of acceptance, emotion expression, and self-compassion varies,
• the boundary between evidence-based practice and therapeutic branding can blur.

Comparative table of major approaches

Approach	Core assumption	Main techniques	Best-known strengths	Common criticisms
CBT	Thoughts, behaviours, and emotions interact	Cognitive restructuring, exposure, behavioural activation	Strong empirical support; structured; efficient	Can be narrow if context is ignored
Psychodynamic	Unconscious conflict and attachment patterns shape distress	Interpretation, exploration of transference, insight work	Depth, relational focus, meaning-making	Less standardised; time-intensive
Humanistic	People have innate capacity for growth	Empathic reflection, unconditional positive regard	Alliance, autonomy, dignity	Less directive; weaker disorder-specific evidence
Systemic	Problems are maintained in relational systems	Family sessions, communication change	Context-sensitive; relationally informed	Not always feasible or safe
Third-wave	Relationship to thoughts and emotions matters	Mindfulness, acceptance, distress tolerance	Emotion regulation, flexibility	Sometimes loosely defined, uneven evidence

How to compare therapies in an exam

A strong comparative paragraph might argue that CBT is often preferred when the clinical problem is clearly defined and symptom reduction is urgent, while psychodynamic and systemic approaches may be more useful when the problem is embedded in relationships, identity, or chronic maladaptation. Humanistic principles support all interventions by strengthening the alliance. Third-wave therapies add flexibility, especially when rigid control of internal experience is part of the problem. The most defensible conclusion is usually integrative rather than exclusive.

3. Evidence, Outcome Research, and the Problem of “What Works”

The question “What works?” is deceptively simple. In psychotherapy, outcomes depend on diagnosis, severity, comorbidity, treatment integrity, therapist training, client preference, and cultural context. A critical analysis must distinguish between statistical efficacy, real-world effectiveness, and meaningful recovery.

Efficacy versus effectiveness

Efficacy refers to whether a therapy works under controlled research conditions. Effectiveness asks whether it works in ordinary clinical practice.

An intervention can show efficacy in trials but lose power in the field if:

• therapists are less well trained,
• clients are more complex than trial participants,
• appointments are fewer or shorter,
• barriers such as transport, stigma, and poverty interfere with attendance.

This distinction matters greatly in public-sector settings. A treatment model that works in a research clinic with weekly supervision may be difficult to replicate in a crowded hospital outpatient service.

Outcome measures and what they miss

Most psychotherapy studies use standard symptom scales. These are important, but they can also narrow the picture. A client may have lower depression scores yet still experience relational instability, poor functioning, or continued exposure to violence. Conversely, a client may still report some symptoms but function better, sleep more, work consistently, and feel more hopeful.

Important outcome domains include:

• symptom reduction,
• functional improvement,
• quality of life,
• relapse prevention,
• relational functioning,
• client satisfaction,
• safety and risk reduction.

Critical analysis therefore asks whether the therapy is being judged by the right outcome measures. If success is defined too narrowly, a therapy may appear more effective than it truly is in lived experience.

The role of meta-analyses and their limitations

Meta-analyses combine many studies and can offer valuable summary estimates. However, they are only as good as the studies included. Problems include publication bias, heterogeneous samples, variable treatment quality, and differing control conditions.

A therapy may look powerful when compared with waitlist controls but less impressive when compared with active treatments. This is a crucial exam point. Waitlist comparisons often overestimate effect because clients on waiting lists may deteriorate or improve less simply due to receiving no treatment. More rigorous comparisons use active treatment controls, but differences may shrink.

Why some therapies seem better than others

When a therapy outperforms another, several explanations are possible:

1. Genuine superiority
   The therapy contains more effective mechanisms.

2. Better fit for the disorder
   Exposure is particularly suited to anxiety, so anxiety-focused therapies may outperform generic supportive approaches.

3. Greater treatment fidelity
   A wellmanualised therapy may be delivered more consistently than an eclectic one.

4. Therapist allegiance
   Researchers and clinicians may unconsciously favour the approach they believe in.

5. Sample characteristics
   One group may have more severe symptoms, more comorbidity, or different cultural backgrounds.

A critical writer should avoid concluding too quickly that one school is universally superior. The better claim is often that certain techniques are particularly effective for certain problems.

Disorder-specific evidence and clinical implications

Depression

Evidence strongly supports CBT, behavioural activation, interpersonal therapy, and some forms of psychodynamic therapy for depression. Behavioural activation may be especially efficient because it targets withdrawal and inactivity directly. A critical point is that depression is heterogeneous: some clients present with self-criticism and cognitive distortions, while others are affected by grief, trauma, or social defeat. The therapy must match the profile.

Anxiety disorders

Exposure-based interventions are among the most robustly supported for phobias, panic, and obsessive-compulsive disorder. Here, a critical analysis should emphasise that behavioural learning, not only insight or reassurance, drives change. Avoidance is a maintaining factor, so therapies without exposure may be less effective for these conditions.

PTSD and trauma-related difficulties

Trauma-focused therapies often combine exposure, cognitive restructuring, and emotion regulation. However, trauma work must be paced carefully, and interventions should consider ongoing danger. A therapy that assumes a past traumatic event is over may fail when the client still lives in an unsafe environment.

Personality pathology and chronic dysregulation

Longer-term therapies, including psychodynamic therapy, schema therapy, and DBT, may be more suitable for complex personality difficulties. The central issue here is not just symptom relief but relational stability, emotion regulation, and identity coherence. Simple symptom checklists may understate the value of these therapies.

A comparison of evidence quality

Problem area	Interventions with strong support	Key critical issue
Depression	CBT, behavioural activation, interpersonal therapy	Outcomes depend on severity and social stress
Anxiety disorders	Exposure-based CBT, panic-focused work	Avoidance reduction is essential
OCD	Exposure and response prevention	Treatment discomfort is high but necessary
PTSD	Trauma-focused CBT, exposure-based approaches, EMDR in some settings	Safety, pacing, and retention matter
Personality difficulties	DBT, schema-focused, psychodynamic approaches	Long-term change is harder to measure

The significance of relapse and durability

Short-term improvement is not the same as lasting change. A treatment may reduce symptoms immediately but fail to protect against relapse. Critical analysis should ask whether the intervention builds skills that generalise beyond therapy and persist after treatment ends. For example, exposure-based learning may be durable because clients learn they can tolerate feared cues. Behavioural activation may also support long-term functioning by rebuilding routines. In contrast, interventions that provide temporary reassurance without changing underlying patterns may show weaker durability.

Interpreting null or mixed findings

Mixed results do not automatically mean a therapy is ineffective. They may indicate:

• inappropriate outcome measures,
• poor implementation,
• mismatch between intervention and problem,
• sample heterogeneity,
• insufficient dosage,
• or the need for more targeted application.

A thoughtful exam answer acknowledges uncertainty rather than forcing certainty. Psychotherapy research is not a competition to declare a single winner; it is a map of differential utility across contexts.

4. Clinical Application, Ethics, Culture, and Context in South African Practice

Psychotherapeutic interventions do not occur in a vacuum. They are embedded in social systems, economic realities, and cultural meanings. For students at Wits University, critical analysis should account for South African clinical contexts, where inequality, community violence, unemployment, language diversity, and resource constraints shape both distress and treatment delivery.

Culture and meaning in psychotherapy

Culture influences how distress is expressed, understood, and treated. Some clients present with somatic complaints, spiritual explanations, or relational concerns rather than direct emotional language. Others may conceptualise symptoms through family, religious, or community frameworks. A therapy that assumes individual verbal introspection as the universal norm may fail to connect.

Critical issues include:

• whether the model pathologises culturally normative behaviour,
• whether therapeutic language is accessible,
• whether interventions respect spirituality and communal values,
• and whether concepts like “insight” or “self-assertion” have the same meaning across contexts.

A culturally responsive therapist does not simply “add culture” to a fixed model. Instead, the therapist adapts formulation, examples, metaphors, pacing, and goals while preserving evidence-based principles where appropriate.

Socioeconomic adversity and structural stress

Many clients face poverty, overcrowding, food insecurity, joblessness, gender-based violence, and unstable housing. These are not background details; they are active determinants of mental health. A purely intrapsychic model can unintentionally blame the client for symptoms produced or maintained by social adversity.

For example:

• A client with depression may not be “avoiding life” in a simple behavioural sense but may be exhausted by caregiving, transport costs, and constant financial stress.
• A trauma survivor may struggle with hypervigilance because the environment remains dangerous.
• A person with panic symptoms may have little room for extended exposure homework if daily survival already consumes energy.

Thus, critical analysis must ask whether the therapy addresses the material reality of the client’s life or only the internal experience detached from context.

Ethics: beneficence, autonomy, nonmaleficence, justice

Ethical evaluation is central to psychotherapy. The major principles include:

• Beneficence: promoting client welfare,
• Nonmaleficence: avoiding harm,
• Autonomy: respecting informed choice,
• Justice: fair access and equitable treatment.

Therapeutic interventions can violate these principles when used rigidly. For example, exposure done without proper preparation can increase distress or dropout. Interpretive psychodynamic work can become intrusive if the therapist moves too quickly. A therapist who over-relies on technical expertise may neglect client autonomy.

Justice is especially important in South African contexts where access to private mental health care is uneven. An intervention can be efficacious yet unjust if it is unavailable to those who need it most. Hence, critical analysis includes not only whether the therapy works, but who can actually receive it.

Risk, safety, and clinical judgment

Psychotherapy must be adapted to risk. High suicidality, self-harm, psychosis, severe dissociation, intimate partner violence, and active substance dependence may require stabilisation before deeper work. A therapy that assumes sustained reflective capacity may not be appropriate at all times.

Clinical judgment involves deciding:

1. whether the client is currently safe enough for therapy,
2. whether immediate crisis management is needed,
3. whether a more supportive or structured intervention is warranted,
4. and when referral or multi-disciplinary care is indicated.

This is an essential critical point: the “best” therapy is not necessarily the most theoretically elegant one, but the one that is safest and most useful in the current phase of care.

The therapeutic alliance as a contextual and ethical factor

The alliance is not only a “common factor”; it is also an ethical relationship. It depends on trust, collaboration, agreement on goals, and agreement on tasks. If a client feels misunderstood, patronised, or coerced, even a technically sound intervention may fail.

Alliance is especially important in contexts of historical mistrust, stigma, and prior negative encounters with institutions. A client who has been dismissed by healthcare systems may require more time to build rapport. That time is not wasted; it is often the basis of meaningful engagement.

Practical adaptation in South African settings

A strong critical analysis should include examples of adaptation:

• using local metaphors to explain cognitive distortions,
• incorporating family or community supports when appropriate,
• delivering briefer, focused interventions in high-demand clinics,
• collaborating with social workers and medical staff,
• and considering multilingual practice and interpretation carefully.

Example of context-sensitive formulation

Consider a young adult presenting with panic symptoms, insomnia, and hopelessness after losing employment. A narrow formulation might focus on catastrophic thinking alone. A broader formulation would include financial stress, loss of identity, family pressure, and fear about the future. CBT strategies may help with panic, but problem-solving, social support, and referral for practical assistance may be equally important. This is what critical, context-aware psychotherapeutic work looks like: combining technique with social understanding.

5. Exam Strategies, Comparative Judgement, and High-Quality Answer Construction

To perform well in PSYC4089, students must move beyond memorisation and demonstrate evaluative reasoning. The strongest answers are structured, comparative, and nuanced. They show that psychotherapeutic interventions are not abstract doctrines but clinical tools whose value depends on evidence, setting, and client need.

How to structure an exam answer

A reliable structure is:

1. Define the intervention clearly
2. State the theoretical basis
3. Summarise the evidence
4. Critically evaluate strengths
5. Critically evaluate limitations
6. Consider cultural, ethical, and contextual factors
7. Conclude with a balanced judgement

This structure ensures the answer is not merely descriptive. It also helps prevent a common student error: writing a list of therapy features without taking a position.

What examiners usually look for

Examiners typically reward:

• conceptual accuracy,
• comparison across therapies,
• integration of evidence and theory,
• awareness of limitations,
• application to cases,
• and clarity of argument.

They generally do not reward vague praise such as “this therapy is very effective because it helps people.” That statement lacks evidence, precision, and evaluation.

How to compare therapies in a high-level way

When comparing interventions, focus on domains such as:

• problem fit: which disorders or presentations suit the approach best,
• mechanism: how change is supposed to occur,
• delivery: how long it takes and who can deliver it,
• evidence quality: whether support is robust or mixed,
• context sensitivity: whether it works in diverse settings,
• risk management: whether it is appropriate in complex cases.

A comparative sentence might read: CBT has stronger disorder-specific evidence than person-centred therapy for anxiety disorders, but person-centred principles may improve engagement and alliance across all modalities. This kind of sentence shows balance and synthesis.

Common exam pitfalls

Students often lose marks by:

• confusing the aims of different therapies,
• overstating the effectiveness of one school,
• ignoring ethical concerns,
• failing to distinguish between efficacy and effectiveness,
• or treating all clients as if they were interchangeable.

Another common mistake is using criticism without evidence. For example, saying psychodynamic therapy is “too old” is not analysis. A better critique is that some psychodynamic concepts are less operationalised and may therefore be harder to test, although the relational and affective phenomena it addresses remain clinically important.

A model of balanced judgement

The most defensible conclusion in critical psychotherapy analysis is often a conditional one:

• CBT is highly effective for many anxiety and depressive disorders, especially when techniques target maintaining mechanisms directly.
• Psychodynamic, humanistic, systemic, and third-wave approaches offer important contributions where symptoms are embedded in relationship patterns, identity issues, emotion regulation difficulties, or contextual adversity.
• No single therapy is universally superior.
• Effective practice depends on matching intervention to problem, client, context, and therapist competence.

This is the kind of judgement that reflects advanced clinical reasoning.

Case-based comparative reasoning

Case 1: Panic disorder in a university student

A student experiences sudden heart palpitations, fear of dying, and repeated avoidance of lectures. CBT with interoceptive exposure and cognitive restructuring is likely to be highly appropriate because it directly targets misinterpretation of bodily sensations and avoidance. Supportive counselling alone may comfort the student but is less likely to reduce panic maintenance cycles.

Case 2: Chronic relational instability and self-harm

A young adult with unstable relationships, identity confusion, and recurrent self-harm may benefit from a longer-term, structured approach such as DBT, schema therapy, or psychodynamic therapy, depending on formulation and risk. Here the critical issue is that symptom reduction must be paired with emotion regulation and relational work.

Case 3: Depression after unemployment and family strain

A middle-aged client with depression following job loss may benefit from behavioural activation, problem-solving, and supportive work that addresses shame and social stress. If the therapist ignores unemployment and focuses only on distorted thoughts, the formulation may be incomplete.

A useful exam comparison table

Criterion	CBT	Psychodynamic	Humanistic	Systemic	Third-wave
Evidence base	Strong for many disorders	Moderate, improving	Mixed, less disorder-specific	Strong in family/relational issues	Strong for selected conditions
Structure	High	Variable	Low to moderate	Moderate to high	Moderate
Focus	Symptoms, cognitions, behaviour	Conflict, attachment, meaning	Experience, growth, authenticity	Relationships, communication	Acceptance, mindfulness, values
Best suited for	Anxiety, depression, OCD	Chronic relational and personality issues	Engagement, alliance, self-worth	Family and couple problems	Emotion regulation, chronic distress
Main caution	May neglect context	Can be resource-intensive	May lack direct symptom tools	Not always feasible	Can be diluted if poorly delivered

Final synthesis for revision

The deepest lesson in PSYC4089 is that psychotherapy is both science and art. Evidence matters, but so does fit. Technique matters, but so does relationship. Outcome measures matter, but so does lived change. A critical analyst does not worship a single model. Instead, they learn to identify what each intervention does well, where it struggles, and how it can be used responsibly in diverse clinical realities. In an examination, that level of judgement is what separates competent description from advanced psychological analysis.