People seek therapy for a variety of reasons including anxiety, stress, depression, relationship problems, or because they want to resolve issues or trauma from their past. Therapists use a variety of techniques that can help people develop insight, express themselves, and learn healthier ways to cope. When these skills are applied outside of sessions, people often report significant improvements, often in just a few sessions.
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. These guidelines draw from hundreds of studies on therapy approaches that are most effective in treating specific issues and conditions.6
Here are the APA practice guidelines for common mental health conditions:6
- Depression, bipolar, and mood disorders: Acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), cognitive therapy, interpersonal psychotherapy, behavioral activation, emotion-focused therapy, mindfulness-based cognitive therapy
- Anxiety disorders: CBT, relaxation training, exposure therapy, ACTT
- Post-traumatic stress disorder: Prolonged exposure therapy, trauma-focused cognitive behavioral therapy (for kids and teens with PTSD), emotional freedom technique (tapping), cognitive processing therapy, eye movement desensitization and reprocessing (EMDR)
- Obsessive-compulsive disorder: Exposure and response prevention (ERP), ACT
- Eating disorders: Dialectical behavioral therapy (DBT), CBT, nutritional support, interpersonal psychotherapy, family-based treatment
- Borderline personality disorder: Dialectical behavioral therapy (DBT), mentalization-based treatment, schema-focused therapy, transference-focused therapy
- Substance use disorders: Motivational interviewing, contingency management, medication-assisted treatment for opioid use disorder (suboxone/methadone), seeking safety (for people with substance use disorders and PTSD)
- Attention deficit disorders: CBT, stimulant medication
- Relationship conflict: Emotionally focused couples therapy, family-based treatments
How Does Therapy Help?
While there is an abundance of evidence proving that therapy is effective, researchers still don’t fully understand why or how therapy helps people. While there have been several studies on this topic, the results have been hard to interpret. There are several factors that influence whether therapy will help someone and how much it will help them.5,6,8,9
10 Factors That Improve Success In Therapy
The factors that have the most influence on whether therapy will help may come as a surprise to you, as they have little to do with your symptoms or even the type of treatment you receive. You can use these factors to guide your search for a therapist, and to help you get the most out of your therapy sessions.
The 10 factors that have the biggest impact on success in therapy:2,3,5,6,7,8,9
- Strong relationship: 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.
- Buy-in: 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.
- 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.
- Treatment plan: Another key ingredient to effective therapy is a treatment plan with specific goals you want to accomplish in therapy and steps you and your therapist agree to take to achieve these. Making these goals the focus of sessions will help your sessions feel productive.
- Change: 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. When you come to therapy open, willing, and ready to make some changes, you are much more likely to benefit.
- Engagement: 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 mindset: 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.
- Individualized treatment: 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.
- Feeling understood: 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.
- Life circumstances: Having healthy outlets, strong relationships with friends and family, and stable life circumstances makes it much easier to make progress in therapy. These factors are protective, improving your ability to cope and making it easier to experience the beneficial effects of therapy.
The Upward Spiral
Some researchers believe that the benefits of therapy are the result of an “upward spiral” that triggers a series of positive changes in a person’s life.7 Most people have heard of a “downward spiral,” which describes the way that one or two bad things can trigger a sequence of negative events. In fact, many clients come into therapy in the midst of a downward spiral, similar to the example provided below.
You are laid off from your job
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You can no longer afford to pay rent
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You move in with your parents
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Your social life goes downhill
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You become depressed
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You start drinking more
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Your depression worsens
A downward spiral usually begins with a stressful or difficult event that leads to a series of negative thoughts, emotions, and behaviors. Once a downward spiral starts, it can be difficult to stop. Starting therapy can interrupt, and sometimes even reverse, a downward spiral.7 An example of an upward spiral is shown below.
Your first therapy session goes well
↓
You feel hopeful for the first time in a while
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Your mood motivates you to go to the gym and make dinner plans with a friend
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You go into your second session feeling excited and eager
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You learn some new coping skills and set some goals for treatment
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The coping skills help you feel more in control when you get sad
Even small, positive changes in thinking, mood, and behavior can trigger an upward spiral. These ripple effects of these positive changes can make a significant impact on your daily life, improving your mood, making it easier to get things done, and helping you feel more in control, even when you’re upset. In fact, just taking the first step to set up an appointment can be the start of an upward spiral, with 15% of clients reporting an improvement prior to their first therapy appointment.(5)
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” it. 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.
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.
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
What Happens During 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 is a step-by-step guide to finding a therapist and setting up an appointment, as well as what you can expect once you start therapy:
- Searching: 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. After contacting a therapist and confirming they have openings, you may want to ask logistical questions about what insurances they accept, their fees, and their availability. If these match up, you can ask for a consultation.
- 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.
- 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.
- 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.
- 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-plays, 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.
- 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.
- 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.
Common Myths About Therapy
Many people have formed ideas about therapy based on television or movies, but these often aren’t accurate illustrations of how therapy is done today. Many of the myths about therapy come from old and outdated methods used by therapists almost a century ago.
Common myths about therapy include:
- Lying on a couch: Therapy is usually done sitting up and facing the therapist, just like you would in any normal conversation.
- The silent therapist: Therapists are often great listeners, but therapy usually feels more like having a conversation, rather than talking to yourself.
- The mysterious therapist: Most therapists are pretty open and direct with their clients, so you probably won’t have to worry that they are psychoanalyzing you. If you are wondering what’s on their mind, just ask! Most therapists are happy to be transparent.
- Advice giving: In reality, therapists are usually discouraged from giving advice, and instead work hard to help clients find solutions on their own, giving a little guidance along the way.
- Therapy is forever: Many therapists would tell you that the goal of therapy is to no longer need therapy, and as you feel better, will recommend you stop coming or come less often. You are in control of how long therapy lasts. Most clients see benefits in just a few sessions, and the average person in therapy in the US comes to only 4-6 sessions4
- Therapy is for crazy people: Unfortunately, many people still believe that going to a therapist means you are crazy or have a serious mental illness. In reality, many clients in therapy have only mild symptoms or are there to solve a problem or reduce stress, and some don’t even have a diagnosed mental illness.
- Therapy is the cure: The real cure comes from changes you make in all of the hours you are NOT in therapy, and by applying things you learn in therapy to your real life.
- Money-motivated: Almost all therapists chose this line of work because they want to help people, and they aren’t pretending to like you just to get your money.
- Prescribing medicine: In order to prescribe medicine, most states require someone to be a medical doctor, registered nurse, or physician’s assistant. Most practicing therapists do not hold these credentials, and cannot prescribe medication.
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:
| Issue | Changes In thoughts | Changes In feelings | Changes In behavior |
| Depression | More optimism about the future, less self-criticism | Increased energy, improved mood, more motivation | Being more productive, active, and social |
| Anxiety | Less worrying, ruminating, being more present, able to focus | Feeling more calm, less panic attacks, more confidence | Less avoidance, less procrastination, more social interactions |
| Stress | Feeling more focused, present, and less negative thoughts | Feeling more relaxed, open, and less tense, less irritable | Able to focus and get things done, more patient |
| Conflict in marriage | Thinking more clearly in fights, being able to remember what matters | Feeling more close, connected, and affectionate | Less yelling, more open dialogue, finding compromises |
| Alcohol use | Awareness of triggers, considering long term consequences before | Less intense cravings and urges, less moody, less anger, more energy | Stopping after two drinks, not drinking alone, using healthy outlets |
How Long Does It Take Before Feeling the Benefits?
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.
How to Find the Right Therapist For You
Most people begin their search for a therapist online, using a google search or a free online directory. 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.
Final Thoughts: Does Therapy Really Help?
Decades of research prove that therapy is effective, with 75% of people in therapy reporting noticeable improvements, often in only a few sessions.4,5 Because even small positive changes can begin the start of an upward spiral, therapy can mark a new, more positive beginning for you.7 By finding a therapist who you can relate to, opening up, and being willing to put in the work both inside and outside of sessions, you can further increase the likelihood that therapy will work for you.2,3,6,8,9
