Psychotherapy: How It Works & Who It’s Right For

What Is Psychotherapy?

Unlike psychiatrists who treat mental health symptoms with medication, therapists use talk therapy to help clients address root issues, learn more about themselves, and make positive behavior changes that improve their mental health.^{1, 5}

What Is a Psychotherapist?

A psychotherapist is a professional who possesses a master’s degree or higher in the mental health field from an accredited university. Upon receiving a postgraduate degree, they must practice for several years under the guidance of a supervisor before obtaining a license. This license allows them to work independently and provide counseling to individuals, couples, groups, or families depending on their specialty.

Psychotherapy Vs. Counseling

Today, most therapists would agree that counseling, psychotherapy and therapy all describe the same general treatment. Psychotherapy is a somewhat dated term that was created to describe early methods of counseling, which have since evolved and expanded to include a wide range of different types, styles, and approaches.

Who Can Benefit From Psychotherapy?

Psychotherapy can help people struggling with a number of different issues and problems. Most people seeking therapy are struggling with stress, difficult emotions, or symptoms of an underlying mental health issue like anxiety or depression. Therapy can help people find relief from these concerns, as well as help them identify and resolve issues in their work, relationships, or other areas that are impeding their quality of life.

Psychotherapy has proven benefits for people struggling with:^{2, 7, 8}

• Anxiety disorders (i.e. phobias, social anxiety, panic attacks)
• Mood disorders (i.e. depression and bipolar, may also require meds)
• Eating disorders (may require combination of therapy & nutritional support)
• Attention deficit disorders (may require combination of meds & therapy)
• Obsessive Compulsive Disorder (OCD) (may also require medication)
• Posttraumatic Stress Disorder (or PTSD)
• Relationship issues like conflict, infidelity, or separation
• Grief or loss related to the death of a loved one
• Low self-esteem or self-worth issues
• Stress related to work, life transitions or imbalances
• Chronic pain or chronic health issues (in coordination with medical care)
• Substance use disorders and addictions (sometimes combined with meds)
• Personality disorders (i.e. borderline personality disorder, dependent personality disorder)
• Schizophrenia or psychosis (may require combination of meds & therapy)
• Sleep disorders (i.e. insomnia)
• Sexual disorders (i.e. erectile dysfunction)

Does Psychotherapy Work?

Research indicates that most people benefit from therapy. In fact 75% of people who attend therapy report benefitting from their sessions, faring better than 79% of those who do not seek treatment.^{2, 5} Research shows that therapy is effective for almost everyone regardless of their age, diagnosis or even what kind of therapy they receive.^2,4,5

In fact, therapy provides equal, and sometimes even better, results for people than medication alone. Compared to medication, improvements in therapy also tend to happen more quickly and last longer, even continuing after a person completes treatment.^2,4 Because therapy is safer and has fewer adverse effects than medication, it is considered a frontline treatment for most mental health issues.

How Does Psychotherapy Work?

Researchers know that therapy works, but are less clear on how and why therapy works. What has become clear from research is that the type of therapy a person gets only plays a small part in the process. Most researchers agree that finding a “good fit” between the client and therapist is the most important factor that determines whether therapy will be helpful.^{4, 5, 6}

The factors that have the most influence on the effectiveness of therapy include:^{4, 6}

• Personal preference: What style, approach, and type of therapy a person prefers, including the characteristics they look for in a therapist
• Expectations: Whether the client expects to benefit from therapy and how much they expect to benefit, with too low or too high of expectations leading to poorer results
• Trust: Whether the client feels comfortable opening up to a therapist and the extent to which they feel their therapist is knowledgeable, trustworthy, and truly invested in them
• Collaboration: Whether the client and therapist are able to build a collaborative relationship where they communicate and work well together
• Consensus: Whether the client feels like they are on the same page with the therapist about what the problem is, what the goal is, and how to reach it
• Engagement level: How motivated and engaged the client is in therapy and whether they are ready, willing, and able to make changes in their life

How to Know If You Need Therapy

It’s normal to feel hesitant about therapy, but seeking help when you need it can make a huge difference in your quality of life. Consider checking in with yourself to gain insight into whether it’s time to go to therapy or not.

Here are some signs that you should seek therapy:

• The issue is causing you distress: You are having difficulty functioning with day-to-day activities and have not been feeling like yourself for a while which is negatively impacting your overall well being.
• You’re using unhealthy coping mechanisms: You may find yourself engaging in self-destructive patterns to cope such as excessive drinking, substance misuse, self-harming behaviors and so forth.
• Family members and friends have mentioned their concern: You may notice a change in your interactions with others and often hear from friends and family how worried they are about your mental wellness.
• You’ve tried other ways to heal with no success: You have tried to overcome your emotional and mental struggles by reading self-help books, meditating, or making other lifestyle changes, but still feel like you haven’t made progress.

Common Benefits of Psychotherapy

There are many proven physical, social, and emotional benefits of therapy. Many times, the benefits in therapy happen early on. Between 20-50% of clients in psychotherapy describe “sudden gains” or rapid improvements, which usually occur before the sixth therapy session.³

Some of the improvements that people who receive therapy report include:

• Fewer, less frequent, or less intense symptoms
• Improved ability to cope with stress
• Improved mood or energy levels
• Improved ability to function, focus, or complete tasks
• Positive behavior changes or healthier habits
• Better decision making and higher rates of goal achievement
• Improved communication and intimacy in relationships
• Feeling more present, less distracted, and less numb

Are There Any Risks to Psychotherapy?

Although psychotherapy involves little risks, it’s crucial to be cognizant of potential drawbacks that may arise during the process, such as:

Unexpected Negative Feelings

Psychotherapy involves talking about thoughts and emotions that are not necessarily pleasant. It also involves getting out of your comfort zone and dedicating effort into healing. Because the path to recovery is not usually linear, it’s not uncommon to experience a wave of unexpected negative emotions throughout the course of treatment.

Risk of Meeting With an Unhelpful Therapist

Therapy is most effective when you have a strong connection with your therapist that allows for collaborative work. Unfortunately, this is not always the case for everyone, and you may come across a professional who, for whatever reason, is not the right fit for you and by default unhelpful. If this happens to you, know that you don’t have to remain with that therapist and you have every right to look for someone else.

If English Is Your Second Language You May Have a Challenge

If English is your second language, communicating with a therapist who doesn’t speak your language will be challenging. You could get lost in translation and find it harder to express what you’re really feeling. It may be best to work with a practitioner who speaks your native tongue so you can easily discuss your emotions and stressors. Or, if you feel comfortable enough, you can also consider choosing a professional who can accommodate your language needs by having an interpreter present in sessions.

Therapy May Not Be Covered By Insurance, Costing You Money

Many insurance plans do not cover behavioral health and if they do, the co-payments might be high. As such, it is important that before starting treatment you speak with your representative to find out if your insurance plan covers mental health, how much you are expected to pay out of pocket, and if there are limits to the number of sessions your insurance will allow. If none of these apply to you, you can contact your therapist’s office and ask if they have sliding scales or payment arrangement options.

What Are the Types of Psychotherapy?

Different therapists use specific approaches and styles of therapy to help clients, and also may offer therapy in different formats or methods. There are several different formats and types of psychotherapy that may be available to you.

Therapists use a wide range of different styles, approaches, and types of therapy to help their clients. Because there are so many different options for psychotherapy, it’s good to know a little about each in order to find a style that you think will work best for you. While no one type of therapy is better than another, there may be one (or more than one) type that feels like a better match for your needs and preferences.

Here are some of the more common types of psychotherapy:⁸

• Cognitive behavioral therapy (CBT): CBT helps clients identify and change unhelpful thoughts and behaviors that cause stress and symptoms. CBT is used for anxiety, OCD, PTSD, mood disorders, eating disorders, substance use, sleep issues, and behavior problems.
• Exposure therapy: Exposure therapy helps clients gradually face feared situations to reduce anxiety, phobias, panic attacks, and OCD symptoms, often using relaxation techniques and repeated exposure.
• Dialectical behavioral therapy (DBT): DBT is a structured therapy that teaches mindfulness, emotional regulation, and interpersonal skills. DBT is often used for borderline personality disorder, self-harm, and emotion dysregulation.
• Acceptance and commitment therapy (ACT): ACT helps clients accept emotions and reduce reactivity through mindfulness and acceptance strategies. ACT is effective for anxiety, depression, PTSD, OCD, and substance use.
• Eye movement desensitization and reprocessing (EMDR): EMDR uses guided eye movements and processing to help resolve traumatic memories and negative beliefs. EMDR is commonly used for PTSD.
• Motivational interviewing: Motivational interviewing is a coaching approach that supports behavior change, often used for substance use, weight loss, smoking cessation, and other health-related goals.
• Person-centered therapy: Person-centered therapy focuses on building a strong, supportive therapist-client relationship. It helps clients feel heard, understood, and empowered.
• Solution focused therapy: Solution focused therapy uses practical, goal-oriented strategies to help clients solve problems—usually within six sessions or fewer.
• Couples therapy and family therapy: Couples therapy and family therapy improve communication and connection within relationships. Common approaches include the Gottman Method, Emotionally Focused Therapy (EFT), and Internal Family Systems (IFS).

Less common types of therapy include hypnotherapy, somatic experiencing, art therapy, psychodynamic therapy, and psychospiritual approaches. These alternative approaches may be preferred by people who are creative, spiritual, or prefer more holistic approaches.

Formats for Therapy

Here are the most common formats for therapy:

• Individual psychotherapy: Individual psychotherapy involves meeting one-on-one with a licensed therapist to address mental health issues, past trauma, or personal concerns impacting well-being.
• Group therapy: Group therapy brings together individuals with similar struggles (e.g., addiction, grief, divorce) in sessions led by a licensed counselor, and may be combined with individual therapy for deeper support.
• Couples therapy: Couples therapy involves partners meeting together with a therapist to improve communication, rebuild closeness, and address relationship challenges like infidelity, intimacy issues, or conflict.
• Family therapy: Family therapy helps families improve communication and resolve conflict, often recommended when children or teens are in therapy or when a family-wide issue like substance use impacts everyone.

Who Can Offer Psychotherapy?

Psychotherapy can only be offered by a licensed individual who has at least a graduate degree in social work, psychology, or counseling. Most therapists have a master’s degree and at least one license that allows them to provide counseling within their state.

Some of the more common types of licenses a therapist may hold include:

• Social work license (Licensed Clinical Social Worker)
• Professional counselor license (Licensed Mental Health Counselor or Licensed Professional Counselor)
• Addiction specialist (Master Addiction Counselor or Licensed Clinical Addiction Specialist)
• Marriage and family therapist (Licensed Marriage and Family Therapist)

Psychiatrists are medical doctors (MD’s) who specialize in psychiatric medication. They typically do not offer counseling, but instead provide brief consultation appointments for people interested in medication to treat an underlying disorder like depression, anxiety or addiction. Psychologists hold a master’s or doctoral degree in psychology and may or may not offer counseling. Some psychologists provide psychotherapy, while others only offer testing and evaluations.

What to Consider Before Your First Therapy Session

If you have decided to pursue therapy and made an appointment, there are some things to consider that can help prepare you for your first session.

Here are some factors to think through before getting started with therapy:

• What time of day will work best for your schedule: Knowing what aligns best with your schedule can ease some of the tensions many people feel when entering therapy. Once you decide on a date/time, try keeping it the same throughout to help you stay consistent in going.
• Family and childcare responsibilities: Make sure that family and childcare responsibilities are organized in a way that won’t interfere or overlap with your appointment. Having young kids around during a session will only make you feel stressed out and prevent you and your therapist from focusing.
• You may want some space after your session: During therapy sessions, difficult emotions and experiences will inevitably come up. You might feel emotionally drained afterwards and may need some space to yourself to decompress.
• You should bring any referral notes and a list of your current medications: Many insurance plans require a referral for behavioral care visits. So, make sure you bring that information with you as well as a list of all medications you might be taking.
• You might want to bring a notebook: The first session may be a bit overwhelming since a lot of information will be provided to you. So, bring a notebook to jot down important things or write about anything else that resonates with you that can be used as a journal prompt later.

What to Expect in Psychotherapy

If you have never received therapy before, you might wonder what to expect in a typical session. Normally, the first therapy appointment is all about information gathering, but future sessions tend to be more targeted around accomplishing the goals you want to achieve in therapy.

Some of the common tasks in therapy include:

• Insight building: Your therapist might help you develop more insight and awareness into yourself and your behaviors by asking you questions and helping you explore your thoughts, feelings, and experiences. You might also spend time processing through past experiences to learn about how they continue to impact you.
• Processing emotions: Your therapist might help you process through difficult emotions and experiences in sessions by helping you talk about these issues and explore their impact, while providing you with empathy and support.
• Changing negative thoughts: In therapy, you may be asked to identify unhelpful or negative thoughts that are making your stress or symptoms worse. Your therapist may also teach you certain skills to shift your perspective or think about yourself, your relationships, and your future in new, more helpful ways.
• Behavior change: If you need or want to make a change in your behavior, this might be something you discuss and address in session. Your therapist may help you identify goals, things that get in the way of these goals, and small steps you can take to begin working on them.
• Communication skills: If you have a relationship problem or conflict, your therapist may help you learn different methods of communicating how you feel and what you want and need from others.
• Coping skills: Most people need help learning better ways to cope with stress and painful emotions, so coping skills are a common focus in therapy sessions. Some examples of coping skills include mindfulness, skills that help you reframe negative thoughts, and identifying relaxing and enjoyable activities that decrease stress.

Client/Therapist Confidentiality

Discussions with your therapist are typically kept confidential. However, there may be a few instances when practitioners may breach privacy, like if you pose an imminent threat to yourself or others, in cases of abuse of children/elders which therapists are mandated to report, or if you personally sign a release of information document. Because the standard limits to confidentiality can vary from state to state, you may want to clarify any questions you may have about it with your psychotherapist during your first session.

How Long Will Therapy Last?

The duration, number of sessions, and frequency of treatment can vary from person to person. That’s because this will depend on numerous factors such as the condition or concern being treated, severity of symptoms, presence of a coexisting disorder, the type of intervention being used, cost and health insurance limitations, the client’s progress, and so forth. This is something that should be discussed at the outset of therapy and monitored throughout. Your therapist can assist you to better understand how this process goes and provide you with a potential date when therapy might conclude.

Therapy Plus Medication

In some situations, psychotherapy alone may not be sufficient for someone to efficiently manage their mental health symptoms or other life-concerns. At this point a combination of talk-therapy and medication may be the most effective course of action. If this is your case, talk to your therapist about it. They can refer you to the appropriate professional who can conduct a thorough evaluation and prescribe medication as an adjunct intervention.

Cost of Psychotherapy

The average cost of therapy in the US is between $100-200 per session, but tends to be higher in major cities like Los Angeles or New York City. In these more expensive cities, it isn’t uncommon for a therapist to charge $250 or more per session. Often, people who want couples therapy need to pay out-of-pocket, as most insurance plans do not cover couples therapy.

Mental Health Insurance

If you have mental health insurance, it’s a good idea to contact your insurance company to get a better understanding of what coverage you have for therapy. Often, seeing an in-network therapist will save you money, even if you have a high-deductible plan.

Some questions to ask your insurer include:⁵

• What kind of coverage do I have for outpatient behavioral health/mental health?
• Do I have a copay for outpatient therapy (aka psychotherapy)?
• Do I have a deductible to meet before insurance will begin to pay?
• What is the in-network rate for outpatient therapy sessions (if you have a deductible)?
• Is there a limit to the number of sessions I can receive per year under my plan?
• Does my plan cover individual, group, and couples therapy sessions?
• Is online therapy/teletherapy covered by my plan?
• What is the cost difference between seeing an in-network vs out-of-network therapist?
• Can you provide me with a list of in-network therapists?

Aside from health insurance, there are some employers that offer employee assistance programs (EAPs). Under these plans, you may be eligible for a certain number of free counseling sessions each year, as long as you see someone approved by your EAP. If you aren’t sure if you have EAP benefits, you can check with someone from HR within your company or consult your employee benefit handbook.

If you are unemployed, on disability, or have a low income, you may also qualify for state assistance through Medicaid or Medicare. Often, you can check online or with your state’s Department of Health and Human Services for more information about eligibility or how to apply for Medicaid or Medicare. Some states have a separate set of funds for people who don’t qualify for Medicaid but are in need of mental health or substance use treatment.

Some therapists offer sliding scale rates for clients who cannot afford to pay full price. Because many therapists have given up their offices and are providing 100% online sessions, they may be able to offer reduced rates for online sessions. Today, there are a number of ways to find affordable treatment for people who cannot afford to pay the full price of psychotherapy.

How to Find a Psychotherapist

Most people begin their search for a therapist online by doing a Google search or using an online therapist directory. Directories often provide options to narrow the search by location, insurance type, cost, and area of specialty. There’s also the option of using online therapy platforms like BetterHelp or Talkspace for virtual therapy services.

If you need to find an in-network therapist, you can also call the number on the back of your insurance card or login to an online portal to find in-network therapists.

How to Ensure a Good Fit With Your Therapist

Because finding someone you feel comfortable with is so important, it’s a good idea to ask for a consultation call or to email a therapist with some questions before booking your first appointment. This can help you get more information about their style and approach of therapy. Most therapists offer free 10-20 minute phone or online consultations to help clients make this decision.

Some questions to consider asking before booking a first appointment include:⁵

• Are you accepting new patients? If so, when is your first available appointment?
• What are your areas of specialty?
• Do you have experience treating people with my issue?
• What kind of therapy style and approach do you use?
• What could I expect in a session with you?
• What is your availability like? (especially important if you need evening or weekend appointments)
• Do you offer sessions in-person or online?
• Are you in-network with my insurance (if applicable)? If so, do you direct bill?
• What are your rates (if not using insurance)?
• Do you offer a sliding scale or reduced fee (if you can’t afford the rate)?

Does Online Psychotherapy Work?

The internet has paved the way for new mediums in which to engage in psychotherapy including various online therapy platforms. Online therapy has grown exponentially in the past few years, giving people the opportunity to receive treatment that they may not have had when restricted to in-office visits only. As the demand for web-based therapy continues to expand, so does the research indicating that online psychotherapy can be just as effective as in-person treatment for different populations, health conditions, and therapeutic modalities.^9,10,11