How Does Therapy Work?

Does Therapy Actually Work?

Decades of research suggests that therapy is effective. One in every five Americans struggles with a mental health condition, but less than half will seek treatment.¹ Left untreated, mental health conditions often worsen, but with therapy, 75% of people experience lasting improvements.² In fact, people who attend therapy fare better than 75-85% of those who do not, even when they only attend a few sessions.^{3, 4, 5}

Depending on the issue you have, certain types of therapy may work better than others. Therapists often refer to the American Psychological Association (APA) practice guidelines when making treatment recommendations for their clients. These guidelines draw from hundreds of studies on therapy approaches that are most effective in treating specific issues and conditions.⁶

Does Therapy Work for Everyone?

Not every therapy approach works for everyone, but with so many treatment options available, most people can find a therapist who helps them improve their symptoms and reach their goals. Finding the right therapist for you can take some time, so stay patient and keep the lines of communication open with your therapist.

How Do I Know If I Need Therapy?

Almost anyone can benefit from therapy, even if their issues and symptoms aren’t severe enough that they “need” therapy. If you are going through something challenging, therapy can help you become more aware of your feelings and needs, resolve old issues, and find healthier ways of coping. Even if you’re not sure what you would want to talk about in therapy, the therapist’s job is to ask you the right questions to figure out how to deal with life stressors or just become your best self.

People come to therapy with a wide range of complaints, including:

• High levels of stress
• Anxiety and excessive worrying
• Relationship problems, conflict and breakups
• Grief caused by the death of a loved one
• Past abuse or traumatic experiences
• Overuse of drugs or alcohol to cope
• Unhealthy lifestyle choices or self-destructive behaviors
• Loneliness, sadness, or loss of motivation
• Work-related stress or professional burnout

Left untreated, these issues can worsen over time, even getting to a point where they impact your ability to function and get through your routine.

Signs Therapy Will Be Necessary

Some of the signs that indicate a more urgent need for therapy include:

• Intense, lasting feelings of sadness, anxiety, or anger
• Inability to focus, concentrate, and get things done
• Insomnia, increase or decreased appetite, and rapid weight change
• Suicidal or homicidal thoughts or attempts to self-harm
• Rapid mood swings, reckless behaviors, and risky decision-making
• Inability to work, complete tasks, and follow a normal routine
• Seeing or hearing things other people do not
• Panic attacks or extreme levels of anxiety
• Avoiding people, places, and activities because of mental health issues

How Does Therapy Work?

If you’re just getting started with therapy, you might be wondering how therapy actually works and how to get the most out of your therapy sessions. The most important thing for you to know is that therapy only works well when you have a strong, trusting relationship with your therapist. Along with that, therapy should be a safe space for you to process your life and determine any changes you need to make, and you certainly don’t need to jump into anything before you feel ready.

Here are the basics of how therapy works:^{2, 3, 5, 6, 7, 8, 9}

A Strong Client/Therapist Relationship Is Key

Finding a therapist you like, trust, and feel comfortable talking to is more important than what kind of therapy they provide, how many years of experience they have, or any other factor. It’s important that you and your therapist are on the same page about the problem you have and how you will work together to address it. Feeling “bought in” to treatment is important, and will influence how much progress you will make.

It’s also important to feel like your therapist “gets” you, and understands the way you think, feel, and behave. When you feel understood, therapy is more likely to target the issues that are relevant and helpful for you.

Therapy Is a Safe Space

Therapy is only effective when you are willing to open up and talk about things that are difficult, painful, or hard to accept. Good therapists make this easier by being non-judgmental, warm, and empathetic, creating a safe space for you to be vulnerable.

Your Therapist May Give You a Treatment Plan to Help You Reach Your Goals

Another key ingredient to effective therapy is a treatment plan with specific goals you want to accomplish in therapy, along with steps you and your therapist agree to take to achieve these. Making these goals the focus of sessions will help your sessions feel productive.

You Might Be Given Homework

In order to experience the benefits of therapy, you need to apply what you have learned to make meaningful changes in the way you think, act, and respond outside of sessions. You’re more likely to benefit from therapy when you show up open, willing to change, and practice those changes between sessions.

Therapy Is Not Easy—Your Mindset Matters If You Want Change

The expectations and beliefs you have about therapy play an important role in the therapy process. When you are optimistic about therapy, are willing to put in the work, and like and trust your therapist, you are much more likely to make progress.

Being engaged in sessions doesn’t mean just showing up, listening, and talking. It involves playing an active role in therapy by coming to sessions prepared, staying focused on the topics that matter, and being willing to try new skills.

Your Therapist Should Tailor Their Approach & Plan to Your Needs

A good therapist draws from their existing knowledge and skills, but also works hard to customize their approach to meet your needs. If something is not working for you, it’s important to let them know so that you can work together to revise your treatment plan.

You Shouldn’t Share Anything Before You’re Ready

Your therapist should never force you to do anything or say anything that you do not consent to. The therapist can make recommendations, but the decisions are always yours. You are in charge of your therapy.

Therapy Doesn’t ‘Fix’ You—Because You Are Not Broken

Therapy is not a “fix” or a “cure” for you or your situation. Everyone experiences their own group of setbacks and accomplishments. Therapy is only a tool to help you get from one place to another, and if a therapist makes you feel like you are broken or “not doing enough,” that may be a sign of a bad therapist.

Therapists Do More Than Just Listen

Listening is a key element of what therapists do, but no therapists should only listen. Depending on their style of therapy, some professionals will take more passive or active roles in your treatment. Be sure to discuss your impressions and what you’d like your therapy to include.

But They Also Shouldn’t Tell You What to Do

Just as being too passive is a problem, being too pushy is never a good quality for a therapist. Therapists should strive to help you become a happy, confident person who is capable of making your own decisions. They should help you accomplish your goals without doing the work for you.

Online Therapy Can Work Just as Well

Good therapy can happen in-person or online, whether through a private practice or an online therapy platform. One form isn’t better than the other but some people simply benefit more from one approach than the other. The best kind of therapy is the one that fits your needs and helps you make meaningful progress.

How to Find a Therapist & What to Expect in Therapy

When it comes to therapy and securing your first appointment, you can expect a searching process, consultation, an initial appointment, and, if things went well, a next session. If you’ve never been through this process before, it’s OK to feel unsure.

Here’s how to find a therapist and what to expect next:

1. Where to Look for a Therapist

Many people begin their search for a therapist online by conducting a google search or using a free online directory. You could also contact your insurance company or ask your doctor for a referral. Once you confirm the therapist has openings, ask about logistics like accepted insurance, fees, and availability. If these match up, you can ask for a consultation.

2. Schedule a Consultation

Many therapists offer free consultation calls to answer questions and help you determine if they are a good match. Take advantage of this consultation by preparing a list of questions, including asking about their experience, training, and an overview of what you can expect in sessions.

3. Complete Intake Forms

If you decide to go forward with scheduling a first appointment, you will probably be asked to complete a set of intake forms. These normally include forms for your personal information, insurance information (if applicable) and a little about the issues you want to work on. Consent forms will also be included in this intake packet, and you will need to complete these before your first appointment.

4. Attend Your Initial Appointment

Expect that your therapist will ask you a lot of questions, including getting information about your family, childhood, work, and current circumstances in the first session. They will also ask questions about your mental health, which will be used to determine a diagnosis if you have one. At the end of this appointment, the therapist will discuss your diagnosis (if applicable) and may want to start going over a treatment plan.

5. Attend Next Sessions

After the initial appointment, your therapist may ask to see you weekly, or more or less often depending on your needs. These sessions will be focused on helping you reach the goals you set for yourself and may include role-playing, teaching you new coping skills, or working to make specific changes in your life. You may be asked to do some “homework” outside of sessions, which helps you apply skills you are learning to real-life situations.

6. Treatment Plan Review

Periodically, your therapist will review your goals with you, making sure they still reflect the issues you want to work on. They may also ask you to assess the progress you feel like you are making, and may make suggestions for ways treatment can be adjusted to your current needs.

7. Discharge

Eventually, you may reach a point where you or your therapist feels you no longer need therapy. Often, a therapist will recommend that you come less often after you’ve made progress, and eventually you may feel comfortable stopping therapy. How long you stay in therapy is up to you, but making these decisions with your therapist can help to ensure you have a plan in place to manage your symptoms on your own. Later on, you may decide to return to therapy to continue working on an issue or to address another problem you have.

How Long Does Therapy Take to Work?

It isn’t unusual for progress in therapy to happen quickly and suddenly. In fact, many people notice progress in just a few sessions, and 50% of the improvements made happen by the 8th session. In one study of clients in therapy for anxiety and depression, 50% of people reported sudden improvements in their symptoms early on. In an 18 month follow-up, 83% of the clients reported that their symptoms had not reversed, suggesting that most people experience lasting results.^{4, 5, 7, 9}

While rapid improvements are not uncommon, they don’t happen for everyone. If your symptoms are more severe or if you are under a lot of stress, it may take longer to see results in therapy. This is also true if you have a hard time opening up to people and talking about personal or difficult topics.

For some people, therapy is most effective when it is combined with psychiatric medication, group therapy, or a support group. Also, making healthy lifestyle changes like eating better, exercising more, creating more work/life balance, or starting a meditation routine can also accelerate your progress in therapy.

What Counts as “Success” In Therapy?

Success in therapy depends on the particular issue you are trying to resolve. In your first or second session, your therapist will work with you to identify one or more goals for therapy, and will work with you to outline a plan to achieve these.

Depending on the issue you want to resolve, success in therapy may involve:

• Finding healthier ways to cope with stress and difficult emotions
• Improving communication or work on developing healthier relationships
• Reducing the negative impact of difficult emotions
• Increasing self-esteem, becoming less insecure or more confident
• Making healthier choices and forming good habits
• Resolving old issues, trauma, and unhealed emotional wounds
• Developing more self-awareness, clarifying values, and setting long-term goals
• Identifying and addressing sources of stress
• Responding to stress and challenging situations more effectively
• Improving your mood, energy, or motivation levels

How Will You Know When You’re Making Progress?

The more specific you can be about the desired changes in your thoughts, feelings, and behaviors, the easier it will be to identify your progress. If you were to reach this goal, what would be different about your routine? What changes would you notice in yourself? What changes would someone close to you be able to notice?

Here are some examples of specific changes that can indicate someone is making progress in therapy:

Most people begin their search for a therapist online, using a Google search, online therapist directory, or an online therapy platform. Online therapy platforms can be a convenient option, especially for those seeking flexible scheduling, remote access, or a streamlined matching process.

When choosing a therapist, it’s important to find someone who is a good match for you. Practical factors like cost, insurance, and scheduling are important to consider, and it’s also important to find a therapist who has experience treating the issue you want help with.

Finding someone who you like, trust, and relate to is also important, so consult with a few therapists before making a decision to schedule an appointment. If you aren’t getting what you need from your therapist, remember that it is OK to bring up your concerns. Most therapists are open to feedback on how they can adjust treatment to better meet your needs or are willing to help you find someone who can.