A hierarchical framework of four psychotherapeutic levels as applied to general psychiatry is proposed: types A, B, C and D. Each is related to particular psychological schools, modes of therapy, professional groupings and service settings. Type A psychotherapy or the humanistic model is founded on the generic skill of sympathetic listening characteristic of the primary care environment, but is practised throughout the health and social care system. In psychiatry it also extends to the so-called empathic technique that characterizes the psychiatric interview and underpins psychiatric diagnosis and treatment. Type B psychotherapy, or the cognitive model, is based on the belief that aberrant reasoning or miscognition can lead to mental disorder. It is more a more specialist therapy, comprising focused interventions for a wide range of disorders. It is typically located in secondary care services (e.g. Community Mental Health Teams) and is delivered by staff (often embedded psychologists but sometimes psychiatrists and other workers) who have received specific training. Type C psychotherapy or the psychodynamic model emphasizes unconscious processes and internal conflict in the formation of symptoms and the impact on the therapeutic relationship. It is more typical of tertiary care, delivered by dedicated psychotherapists and psychiatrists working either in specialist service settings (e.g. day hospitals for personality disorder) or providing consultation and support to general psychiatry. Type D psychotherapy is equated with a group and family model and is found in use across a broad range of service settings, in terms of the dynamics of the multidisciplinary team and in both formal and informal patient and family groups for the purposes of treatment and rehabilitation.