Someone entering therapy will encounter approaches that treat their thinking in fundamentally different ways. The disagreement is not stylistic; it follows from different accounts of what causes distress to persist.
One tradition treats thoughts as evaluable claims
Cognitive approaches hold that distress is maintained partly by beliefs that are inaccurate or excessively rigid, and that examining those beliefs can change the distress.
Sessions therefore involve identifying specific thoughts, looking at the evidence for them, and constructing alternatives that fit the evidence better.
The assumption is that thought content matters directly, so changing what somebody concludes changes how they feel and act.
Another treats the relationship to thoughts as the target
Acceptance-based approaches argue that attempting to dispute a thought grants it importance and keeps attention on it.
The work is instead aimed at changing how thoughts are held, so that they can be present without determining behaviour.
Under this account somebody can have a distressing thought and act according to what they value anyway, which is the outcome sought rather than the thought disappearing.
A third looks at where the pattern originated
Psychodynamic approaches attend less to the content of current thoughts than to recurring patterns and what those patterns are protecting against.
Material from earlier relationships is treated as relevant because it shaped the expectations a person brings to present ones.
Sessions are correspondingly less structured, since the pattern is expected to appear in the therapeutic relationship itself rather than only in what is reported.
Behavioural approaches largely bypass the question
Some approaches focus on what a person does and what follows from it, on the grounds that changing behaviour changes the situations producing the thoughts.
Activity scheduling for low mood is the clearest example, aiming at contact with reinforcing experiences rather than at what somebody believes.
These methods often produce cognitive change without addressing thoughts directly, which is part of the evidence used to question whether direct disputation is necessary.
Why the disagreement is not resolved
Comparative trials tend to find broadly comparable results for these approaches across common conditions, which leaves the theoretical dispute open.
What differs more reliably is what a session feels like, and that difference matters for whether a particular person can engage with it.
Which approach suits an individual is a question for discussion with a qualified practitioner, since availability and clinical guidance vary by condition and by country.