What Is Psychotherapy?

What is psychotherapy?

Psychotherapy is a treatment in which you work with a trained mental health professional to understand and change patterns in thoughts, emotions and behaviors. It is used for a wide range of concerns — from diagnosable conditions such as depression and anxiety to relationship difficulties, grief, stress and major life transitions.

How therapy helps

Therapy provides a confidential, supportive space to talk openly, and structured ways to make change. Depending on the approach, therapy may help you:

• Understand what is contributing to how you feel
• Learn skills to manage emotions, stress and difficult thoughts
• Change behaviors that keep problems going
• Improve communication and relationships
• Process painful experiences

Common types of therapy

• Cognitive behavioral therapy (CBT) — focuses on the links between thoughts, feelings and behaviors.
• Dialectical behavior therapy (DBT) — builds skills for emotion regulation and distress tolerance.
• Exposure therapy — helps you gradually face feared situations.
• Interpersonal therapy (IPT) — focuses on relationships and life events.
• Psychodynamic therapy — explores patterns rooted in past experiences.
• Acceptance and commitment therapy (ACT) — builds psychological flexibility and values-based action.
• Couples and family therapy — work with relationships as a whole.

What to expect

In your first session, the therapist will usually ask about what brings you to therapy, your history and your goals. Together you will agree on a plan. Sessions typically last around 50 minutes and are often weekly at first.

It is normal to feel nervous. You can ask your therapist about their approach, training, and how you’ll know whether therapy is helping.

Does psychotherapy work?

Decades of research show that psychotherapy helps many people. Large reviews find that, on average, people who receive therapy do better than those who don’t, with benefits that often last beyond the end of treatment. Different therapies tend to perform similarly for many common problems, and the quality of the relationship between you and your therapist, known as the therapeutic alliance, is one of the more consistent predictors of success. For some conditions, specific treatments have a stronger evidence base: exposure-based CBT for OCD and phobias, trauma-focused therapies for PTSD, DBT for borderline personality disorder and CBT for insomnia, for example. Not everyone improves, and about one in three people see little change, which is why reviewing progress and adjusting the approach matter.

What therapy is not

Therapy isn’t just giving advice, and a therapist won’t tell you what to do. It isn’t a quick fix, and it can feel uncomfortable at times. It isn’t only for people in crisis, either; many people use therapy to understand themselves, improve relationships or navigate change. And although therapy and medication are sometimes compared, they are often combined, and decisions about medication are made with a prescriber.

Who provides therapy

Titles vary by country and state. Psychologists typically have doctoral training and can provide assessment and therapy. Licensed professional counselors, clinical social workers, marriage and family therapists and psychiatric nurse practitioners provide therapy under different licenses. Psychiatrists are medical doctors who diagnose and can prescribe medication, and some also provide therapy. When choosing, check the license, training in the approach you want and experience with your concern.

Understanding the main families of therapy

• Cognitive and behavioral therapies focus on thoughts and actions in the present and use structured skills. See CBT, DBT and exposure therapy.
• Psychodynamic and psychoanalytic therapies explore how past experiences and unconscious patterns shape current feelings and relationships.
• Humanistic therapies emphasize empathy, self-understanding and growth, such as person-centered therapy.
• Interpersonal therapy focuses on relationships, grief, role transitions and conflict.
• Third-wave and acceptance-based therapies, such as ACT and mindfulness-based approaches, teach a different relationship with thoughts.
• Relational therapies work with couples and families as systems; see couples therapy and family therapy.
• Trauma therapies target the effects of traumatic experiences; see trauma therapy.

How long does therapy take?

Some focused therapies last 8 to 20 sessions, while longer-term therapy for complex or long-standing difficulties can last a year or more. The right length depends on your goals, the problem and the approach. A good therapist reviews progress regularly and talks with you about when to taper or finish. Some people return for “booster” sessions at stressful times.

How to tell whether it’s working

Signs of progress can include feeling understood, using skills in daily life, symptoms easing, handling situations differently and noticing small changes others point out. Short questionnaires can track symptoms over time. If you don’t feel any better after several weeks, or you feel the fit isn’t right, raise it with your therapist; they may adjust the approach or suggest someone better suited. See our guide to how to find the right therapist.

Confidentiality and its limits

What you say in therapy is generally confidential, which makes it possible to talk freely. There are limits, which your therapist should explain at the start, typically including serious risk of harm to yourself or others, certain abuse reporting duties and legal requirements. Ask about how notes and records are stored and who can see them.

Therapy online, in person and with support from medication

Therapy can be delivered in person, by video or phone, or through guided programs; see online therapy. For moderate to severe conditions, combining therapy with medication is often effective; see antidepressants and anti-anxiety medications. If you are in crisis, see Get Help Now.

Finding a therapist

Look for a licensed professional with experience in your concern, and consider practical factors such as cost, availability and format. Our guide on how to find the right therapist walks through the steps.

Online services can make this easier: BetterHelp matches you with a licensed therapist, while Sesame lets you choose one from a marketplace at upfront prices.