While psychotherapy has been studied for more than 100 years, varied results, difficulty defining constructs, and the changing landscape often prevent a clear response to this simple inquiry: Does therapy work? However, the overwhelming consensus in response to this question is a resounding yes. More specifically, the impact of psychotherapy on overall functioning is significant, far-reaching, and long-lasting, with two-thirds of recipients reporting improvement after treatment.1,2
Talk therapy is often recommended to individuals with relational, emotional, psychological, or behavioral issues. People choose to enter therapy for a variety of reasons, including wanting to improve relationships, gain coping skills for unwanted behaviors and emotions, unburden themselves of guilt and shame, understand themselves better, and help from an independent party in making a decision, to name a few.
By and large, when asked if therapy helped with the above-mentioned issues, most clients report relief after partaking in treatment. The vast majority of those seeking relief are able to find it when matched with a therapist who is capable of facilitating a strong therapeutic relationship.3,4
The Effectiveness of Therapy Is Complicated
Evaluating the effectiveness of therapy is a complex task with many considerations unique to the intricate nature of being a human. While one might be inclined to say, “therapy works,” it is important to consider what constitutes “works” and who it “works” for.
Identifying a measurable construct to evaluate goal attainment in therapy is challenging, and establishing a universal measure of success in therapy is impossible as each person who enters treatment has a unique goal and life desire. Clearly defining what successful psychotherapy looks like is difficult and there are many variables used to indicate a positive outcome.
Broad statements about the effectiveness of therapy are often made with little expounding on the outcome that indicates successful treatment. Is therapy effective at reducing symptoms? Increasing life-fulfillment? Acceptance of issues? Relating with others? There are many factors to consider when evaluating the outcome of therapy.
In addition, it is far easier to measure the effectiveness of a pill due to the fact that each of the pills taken will be the exact same dose and form. Medication trials are also “easier” because the best studies are done using a placebo pill. Both the research subject and researcher can be made blind to whether they are getting treatment or are a part of the “control” or non-treatment group.
Measuring the effectiveness of Cognitive Behavioral Therapy (CBT), for example, is more complicated because it is much more challenging to do “placebo” therapy, and each practitioner also brings a human element into the treatment that is extremely difficult to control for or eliminate.
While universal statements about the effectiveness of psychotherapy in managing and helping with a variety of client issues and concerns are not possible, much effort has been put into defining evidence-based or best-practice approaches to therapy to help with universal human concerns.
For many years, psychological researchers have attempted to identify what approaches to psychotherapy are most effective in helping with different client issues. From this research, the effectiveness of psychotherapy is easier to define and the practice of therapy can be more deliberate.
Therapy in Conjunction with Medication
In general, medication and psychotherapy in conjunction elicit the most long-lasting and significant outcomes.3,4 While talk therapy alone is effective in treating a variety of mental health issues such as depression and anxiety, a large majority of the general public might choose to try medications before psychotherapy due to convenience and desire for fast relief.
Major pharmaceutical companies have the market in treating emotional and behavioral disorders, even though these treatments might not be as efficacious as psychotherapy.3 However, medication can lead to unwanted side effects or have low efficacy rates, leaving many contemplating talk therapy.
Medication alone does not produce as long-lasting benefits as psychotherapy and often requires supportive treatments in conjunction with medication use for improved outcomes. However, psychotherapy alone can produce more significant outcomes without ancillary services.1
In addition, psychotherapy may be more cost-effective in the long-term than medication for the treatment of mental health concerns. For example, research found the cost of CBT was more than medication for the first 16 weeks of treatment, but the use of medication lasted longer, thus having a higher total cost. Some estimate that the cost of two years of SSRI treatment would be 33% more than using a traditional CBT approach to psychotherapy.5
Effectiveness of Therapy for Disorders
While the effectiveness of psychotherapy is more determined by the individual characteristics of the client, it is important to understand the efficacy of talk therapy treatment with various mental health disorders.1 These characteristics could include the chronic nature of the concern, the social supports present in the client’s life, and the severity of symptoms.
Anxiety can range from debilitating to motivating. When seeking treatment for anxiety that is influencing life in a negative and harmful way, research shows a behavioral approach to therapy, with or without medication, yields significantly positive results.6 CBT for the treatment of anxiety has also been found to be slightly more effective than other modalities in part due to the structured and directive nature of this approach.2 Talk therapy for the treatment of anxiety disorders should be considered a first line treatment, or at least used in conjunction with medications.
Psychotherapy is as effective at treating depression as medication and may be more effective at preventing relapse of symptoms after treatment has discontinued.7 A common misconception in the general public is that we have definitive links to depression being caused by chemical imbalances in neurotransmitters.4,5,8
Most are shocked to learn that researchers do not have definitive evidence to support the theory that depression is solely caused by a chemical imbalance in the brain, and the more scientists learn about depression, the more they look toward other biological structures and mechanisms that contribute to depression symptoms.5
CBT in the treatment of mild depression is effective with or without medications, while more severe depression may require a combination of therapy and medication.5 In general, there are many different approaches of psychotherapy used effectively in the treatment of depression. There is growing genetic and biomarker evidence that some individuals will be much more likely to see positive responses to antidepressants than will others.
Borderline Personality Disorder
Personality disorders are an enduring pattern of behavior and interacting with the world that are chronic and can be debilitating. There are no psychotropic medications specifically developed to address the disorder itself. Instead, those with personality disorders may receive prescriptions for psychotropic medications to address symptoms of depression, anxiety, or trauma which are often associated with this classification of disorders.
Talk therapy is the first line treatment for borderline personality disorder and may be most effective at decreasing anger and suicidality, in addition to increasing overall functionality.9 Specifically, dialectical behavior therapy has been identified as a best-practice approach to the treatment of this disorder.10
Medications are often key to the treatment of ADHD, as it is the most effective means of reducing symptoms.11 However, many parents may be concerned about giving medication to younger children while their brains are in such vital moments of development. For these individuals, psychotherapy can lead to meaningful outcomes and reduced symptoms. Adults with ADHD may also benefit most from CBT treatment to increase organization and planning while coping with distractibility.12
Like other disturbances in mood, bipolar disorder seems to respond well to psychotropic medication intervention. While medications are effective in treating this classification of disorders, talk therapy has also shown promising results in decreasing symptoms and reducing relapse.
Specifically, evidence-based therapy treatment for bipolar disorder, in conjunction with medication, showed the most significant outcomes from meta-analysis. Also, those receiving individual or group psychotherapy had better outcomes than those receiving no supportive services.13 CBT in particular has been found to be effective in reducing symptoms and preventing mood changes.14
Other Types of Disorders
There is significant data regarding the effects of therapy on other disorders, including trauma, obsessions and compulsions, psychosis, and addiction.
Individuals who have experienced a trauma, such as those diagnosed with PTSD, can benefit from psychotherapy. Research shows consistent efficacy with a variety of approaches related to trauma and there are several options for the general consumer wanting relief from symptoms related to past traumas.15 The key is in finding a therapist who is trauma-informed and able to practice from a variety of approaches.16
Obsessions and Compulsions
While psychotherapy is effective at treating and preventing relapse of a variety of mental health disorders, those with psychosis show mixed outcomes with the use of therapy. First line treatment for psychosis is medication, and research has shown that CBT is effective at reducing symptoms of psychotic disorders. On top of that, Family Interventions (FI) are effective at reducing relapse of psychosis in clients.19
There are a variety of psychotherapeutic interventions and types of therapies that are used in the treatment of addictions. These various approaches, such as CBT, DBT, Motivational Interviewing (MI), and 12 step models, show efficacy in reducing cravings and relapse in a variety of clients with addictions.20
Effectiveness of Common Types of Therapy (Techniques/Approaches)
There is a common misconception that Cognitive-Behavioral Therapy (CBT) is the most effective form of psychotherapy for all issues because research continues to point to the effectiveness of this form of treatment. While CBT is an extremely important and useful approach to mental wellness, other approaches also have positive findings that are not as numerous, in part due to the difficulty in standardizing these approaches.4
Humanistic therapies, for example, are notoriously difficult to research due to the human element that cannot be controlled for, and the importance of the relationship in facilitating change, which can be difficult to measure. Due to the lack of systematic interventions inherent in this approach, it can be difficult to create a meaningful research study that can be applied and generalized. However, most approaches to psychotherapy are found to be effective in treating a variety of psychological issues.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is often promoted as the most effective form of talk therapy practiced today. When seeking information on treatment modalities for a myriad of mental health concerns, most information will point to CBT as an evidence-based and best-practice treatment.1,6,14,7,15,12,5,17,2,21,22,13,11 CBT has continuously shown good outcomes when used to treat a variety of mental health disorders and is often a more cost-effective treatment option due to the brief and time-limited nature of this therapy.5
Humanistic approaches to psychotherapy, such as person-centered or gestalt therapy, are much more difficult to study than cognitive-based approaches as the relationship is the vehicle for improvement within this modality. When practicing from a humanistic approach, therapists often do not follow a standard process or set of interventions.
This lack of standardization makes generalizable research on this approach difficult. However, humanistic approaches seem to be most effective in treating relational issues and problems.2 In addition, meta-analyses show that individuals participating in humanistic psychotherapies demonstrate a large amount of growth that remains stable over time.23
Solution-Focused Brief Therapy
Solution-focused brief therapy (SFBT), a postmodern approach, is one of the shortest approaches to the treatment of mental health concerns, with some clients reporting relief after as few as one session. SFBT has been highly researched and results continue to point to the assumption that it has treatment outcomes on par with CBT and IPT but in fewer sessions.24 Individuals who are experiencing psychological, behavioral, or relational issues should consider SFBT a first line evidence-based treatment.24
The psychoanalytic approach to therapy has been studied in depth and is one of the oldest modalities practiced, with some pointing to the use of techniques from this approach in other evidence-based therapies, accounting for some of the efficacy found.25 Research shows the use of psychodynamic psychotherapy results in outcomes similar to those using other evidence-based approaches with therapeutic benefits continuing after therapy has been discontinued.25
In addition, psychodynamic psychotherapy seems to be helpful for the treatment of depression, as well as some anxiety disorders with little efficacy to support this approach for the treatment of psychosis, obsessive-compulsive disorders, and PTSD.26 Psychodynamic psychotherapy might be most effective in the long-term treatment of borderline personality disorder.26
Interpersonal psychotherapy (IPT) is widely practiced across the globe for a variety of mental health concerns. Efficacy of this treatment modality appears to show this approach has significantly positive outcomes with the treatment of depression in particular.27,28 This approach has been widely studied with calls for more research to fully understand the significance of this approach on a larger scale.27
Dialectical Behavioral Therapy
Dialectical behavioral therapy (DBT) is most notable for its efficacy in the treatment of suicidality in clients with borderline personality disorder.10 However, DBT has also been shown to be an effective approach for treating many behavioral, psychological, relational, and emotional concerns.
Meta-analysis shows DBT is consistently effective at managing and controlling self-destructive behaviors and improving treatment compliance.9 In addition, DBT has been shown to improve outcomes of clients with mood disorders, substance abuse issues, PTSD, and eating disorders.10
Other approaches to therapy include motivational interviewing, logotherapy, and acceptance and commitment therapy.
This approach is widely used for changing unhealthy behaviors and the efficacy of this treatment approach to that end appears to be significant.30
This form of therapy can be efficacious in treating many concerns, especially those dealing with purpose and accomplishing life goals. Logotherapy has been found to decrease anxiety, depression, and aggression in clients.31
Acceptance and Commitment Therapy (ACT)
Who Does Therapy Work For?
Talk therapy can be highly effective for helping with mental, emotional, and behavioral issues and the efficacy and experience of this treatment can vary greatly depending on how it is delivered. While most of the research has been done on the outcomes of individual therapy, there are other types of therapy that can also be effective for a variety of issues and concerns.
Individual talk therapy is often the first type of treatment considered when one has a mental health or relational concern. Individual psychotherapy is researched more than any other approach to therapy and the results vary depending on the type of treatment practiced.
In general, individual psychotherapy is highly effective when there is a good working and collaborative relationship with the provider. Individual talk therapy should be a consideration for anyone looking to improve their mental or relational wellness. In addition, clients need to be willing to try different therapists until they find one that they are comfortable working with.
Family therapy is a treatment of choice for any one experiencing issues in family systems dynamics. It can be common for one member of the family to be identified by the rest of the family as the “problem.” However, the issue often lies within the way the family is operating and working together. While there are several approaches to family therapy, this approach to treatment can be effective at improving a variety of mental health and relational issues.33
Couples therapy is a first line treatment for any couple who is struggling or desiring to be preventative through strengthening bonding and communication. It takes an average of six years in an unhappy relationship before the couple might decide to give therapy a try.34 Couples therapy can be practiced from a variety of approaches and tends to be a more short-term treatment than individual therapy.
When considering the effectiveness of this approach to psychotherapy, outcomes of couples therapy are highly correlated with the level of motivation and timing of seeking help.34 Couples therapy is effective at reducing complaints between partners and increasing communication and collaboration skills.35
Working with children in therapy presents its own unique considerations, especially when taking into account how to measure growth and positive outcomes of treatment with children. There are a variety of approaches relevant to working with children, with many showing a variety of positive outcomes. Evidence-based approaches to therapy with children primarily include CBT approaches and other behavioral therapies.21,22
When to Try Therapy
Deciding to seek therapy can be a daunting decision for most. While most individuals wait until the mental or emotional symptoms become unbearable, it can be most advantageous to seek therapy in a preventative sense.
Those who are beginning to feel overwhelmed with life and/or circumstances, who may be struggling to maintain positive relationships in their life, or who are doubting their choices and second guessing their decisions could benefit greatly from short-term psychotherapy with a trained professional. When receiving treatment from a trained and skilled therapist, research shows talk therapy can be more effective and long-lasting than medication.3
Those with more chronic or severe mental or emotional concerns can experience relief and positive outcomes for seeking a skilled practitioner of talk therapy through short-term or long-term evidence-based approaches. Regardless of the circumstances that require seeking help, the importance of feeling comfortable with the provider and approach taken become some of the most significant considerations when contemplating talk therapy.
Our minds and bodies are good at signaling when we are overwhelmed or need additional support. Listening to these cues and seeking a therapist who you can connect with is a decision that will most likely lead to reduced issues and a renewed sense of confidence.
Some points of consideration or questions to ask when thinking about giving talk therapy a try might be:
- Is the issue or concern creating significant trouble in my life or impacting my ability to function to the level I know I am capable of?
- Who is involved in the issue or is it an individual issue requiring individual attention?
- Am I avoiding anything or preventing myself from something that could help me?
- Could I benefit from getting an unbiased and neutral opinion regarding my issue or concern?
- What kind of relief am I seeking related to the issue?
- Do I feel comfortable sharing my problem with a trained professional?
- How can I present my concern in a way that will allow me to be matched with the most skilled therapist for my issue?
- What do I need to know or do to feel more comfortable in working with a therapist?