I play straight up vanilla for starters. No tilesets. I grew up playing Rogue-likes, so uckily reading ASCII hasn't been a problem for me for a very long time. No mods. I find there's generally enough diversity and challenge without ramping it up. I do alter the init options a bit, so there is that.
I don't use DF Therapist to manage my dwarves. I've run multiple successful forts at 180+ dwarves without a problem. I assign jobs to immigrants when they walk in (unskilled types usually end up as masons), so I usually have a pretty good spread of jobs initially. When the number of dwarves in my fortress gets above 80 or so, I stop caring about each individual dwarf. If I have a job that needs doing in my fort, I find a handful of idle dwarves (of which there are plenty) and turn the appropriate job on. It's an iterative process. At some point in a fortress' life, I have enough jobs turned on on enough dwarves that when I want something done, my dwarves spring into action without me worrying or cursing their laziness.
Yeah, at the 180+ population point, it runs slow, but I fold it into how I approach the game. I generally run the fortress in the background and check back on it every now and again. And while it's running, I read stuff, or work on other projects or whatever else. I don't really get worked up over how slow it's running. Mostly my forts end because I get bored with them and run out of ideas on how to grow them. I'm really looking forward to the addition of inns and other means of interacting with the outside world, since it'll give me additional in-game goals to reach.
I rely on traps only when I'm just starting off and haven't had a chance to develop a military. Once my military starts getting its bearings, I deconstruct the traps (or reposition them to act as a last line of defense; usually cage traps). I leave my fortresses open, with one or two strong bottlenecks that I position my dwarves at. Early on, I relied on archers, but realized that I didn't mind losing a few dwarves here and there to invaders or rampaging megabeasts. It just adds to the background story.
I've never tried to manipulate the artifacts that my dwarves make. I actually enjoy watching one of my mooded dwarves run all over the place and look to see what object they're dragging back to their workshop, even if it only lead me to say "Aww...just an oak log". I don't really bother training up my weapon/armor smiths (I'm not sure I've ever had one get above proficient). I don't delve down after the deep blue metal. It's been a while since I've actively used magma too.
I'm probably not the only one who plays like this, but some days, it seems like I am.