Psychotherapy - Mayo Clinic (2023)


Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist or other mental health provider.

During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behaviors. Psychotherapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills.

There are many types of psychotherapy, each with its own approach. The type of psychotherapy that's right for you depends on your individual situation. Psychotherapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

Why it's done

Psychotherapy can be helpful in treating most mental health problems, including:

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  • Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder or post-traumatic stress disorder (PTSD)
  • Mood disorders, such as depression or bipolar disorder
  • Addictions, such as alcoholism, drug dependence or compulsive gambling
  • Eating disorders, such as anorexia or bulimia
  • Personality disorders, such as borderline personality disorder or dependent personality disorder
  • Schizophrenia or other disorders that cause detachment from reality (psychotic disorders)

Not everyone who benefits from psychotherapy is diagnosed with a mental illness. Psychotherapy can help with a number of life's stresses and conflicts that can affect anyone. For example, it may help you:

  • Resolve conflicts with your partner or someone else in your life
  • Relieve anxiety or stress due to work or other situations
  • Cope with major life changes, such as divorce, the death of a loved one or the loss of a job
  • Learn to manage unhealthy reactions, such as road rage or passive-aggressive behavior
  • Come to terms with an ongoing or serious physical health problem, such as diabetes, cancer or long-term (chronic) pain
  • Recover from physical or sexual abuse or witnessing violence
  • Cope with sexual problems, whether they're due to a physical or psychological cause
  • Sleep better, if you have trouble getting to sleep or staying asleep (insomnia)

In some cases, psychotherapy can be as effective as medications, such as antidepressants. However, depending on your specific situation, psychotherapy alone may not be enough to ease the symptoms of a mental health condition. You may also need medications or other treatments.

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Generally, there's little risk in having psychotherapy. But because it can explore painful feelings and experiences, you may feel emotionally uncomfortable at times. However, any risks are minimized by working with a skilled therapist who can match the type and intensity of therapy with your needs.

The coping skills that you learn can help you manage and conquer negative feelings and fears.

How you prepare

Here's how to get started:

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  • Find a therapist. Get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). Or you can find a therapist on your own, for instance, by looking for a professional association on the Internet.
  • Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a certain number of psychotherapy sessions a year. Also, talk to your therapist about fees and payment options.
  • Review your concerns. Before your first appointment, think about what issues you'd like to work on. While you also can sort this out with your therapist, having some sense in advance may provide a good starting point.

Check qualifications

Before seeing a psychotherapist, check his or her background, education, certification, and licensing. Psychotherapist is a general term rather than a job title or indication of education, training or licensure.

Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master's or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.

Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.

Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline. The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.

What you can expect

Your first therapy session

At the first psychotherapy session, the therapist typically gathers information about you and your needs. You may be asked to fill out forms about your current and past physical and emotional health. It might take a few sessions for your therapist to fully understand your situation and concerns and to determine the best approach or course of action.

The first session is also an opportunity for you to interview your therapist to see if his or her approach and personality are going to work for you. Make sure you understand:

  • What type of therapy will be used
  • The goals of your treatment
  • The length of each session
  • How many therapy sessions you may need

Don't hesitate to ask questions anytime during your appointment. If you don't feel comfortable with the first psychotherapist you see, try someone else. Having a good fit with your therapist is critical for psychotherapy to be effective.

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Starting psychotherapy

You'll likely meet in your therapist's office or a clinic once a week or every other week for a session that lasts about 45 to 60 minutes. Psychotherapy, usually in a group session with a focus on safety and stabilization, also can take place in a hospital if you've been admitted for treatment.

Types of psychotherapy

There are a number of effective types of psychotherapy. Some work better than others in treating certain disorders and conditions. In many cases, therapists use a combination of techniques. Your therapist will consider your particular situation and preferences to determine which approach may be best for you.

Although many types of therapies exist, some psychotherapy techniques proven to be effective include:

  • Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
  • Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you handle stress, manage your emotions and improve your relationships with others
  • Acceptance and commitment therapy, which helps you become aware of and accept your thoughts and feelings and commit to making changes, increasing your ability to cope with and adjust to situations
  • Psychodynamic and psychoanalysis therapies, which focus on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts
  • Interpersonal psychotherapy, which focuses on addressing problems with your current relationships with other people to improve your interpersonal skills — how you relate to others, such as family, friends and colleagues
  • Supportive psychotherapy, which reinforces your ability to cope with stress and difficult situations

Psychotherapy is offered in different formats, including individual, couple, family or group therapy sessions, and it can be effective for all age groups.

During psychotherapy

For most types of psychotherapy, your therapist encourages you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort as time goes on.

Because psychotherapy sometimes involves intense emotional discussions, you may find yourself crying, upset or even having an angry outburst during a session. Some people may feel physically exhausted after a session. Your therapist is there to help you cope with such feelings and emotions.

Your therapist may ask you to do "homework" — activities or practices that build on what you learn during your regular therapy sessions. Over time, discussing your concerns can help improve your mood, change the way you think and feel about yourself, and improve your ability to cope with problems.

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Except in rare and specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety (yours or someone else's) or when required by state or federal law to report concerns to authorities. Your therapist can answer questions about confidentiality.

Length of psychotherapy

The number of psychotherapy sessions you need — as well as how frequently you need to see your therapist — depends on such factors as:

  • Your particular mental illness or situation
  • Severity of your symptoms
  • How long you've had symptoms or have been dealing with your situation
  • How quickly you make progress
  • How much stress you're experiencing
  • How much your mental health concerns interfere with day-to-day life
  • How much support you receive from family members and others
  • Cost and insurance limitations

It may take only weeks to help you cope with a short-term situation. Or, treatment may last a year or longer if you have a long-term mental illness or other long-term concerns.


Psychotherapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope in a healthy way and to feel better about yourself and your life.

Getting the most out of psychotherapy

Take steps to get the most out of your therapy and help make it a success.

  • Make sure you feel comfortable with your therapist. If you don't, look for another therapist with whom you feel more at ease.
  • Approach therapy as a partnership. Therapy is most effective when you're an active participant and share in decision-making. Make sure you and your therapist agree about the major issues and how to tackle them. Together, you can set goals and measure progress over time.
  • Be open and honest. Success depends on willingness to share your thoughts, feelings and experiences, and to consider new insights, ideas and ways of doing things. If you're reluctant to talk about certain issues because of painful emotions, embarrassment or fears about your therapist's reaction, let your therapist know.
  • Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip psychotherapy sessions. Doing so can disrupt your progress. Try to attend all sessions and to give some thought to what you want to discuss.
  • Don't expect instant results. Working on emotional issues can be painful and may require hard work. You may need several sessions before you begin to see improvement.
  • Do your homework between sessions. If your therapist asks you to document your thoughts in a journal or do other activities outside of your therapy sessions, follow through. These homework assignments can help you apply what you've learned in the therapy sessions to your life.
  • If psychotherapy isn't helping, talk to your therapist. If you don't feel that you're benefiting from therapy after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach that may be more effective.

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By Mayo Clinic Staff


What is the failure rate of psychotherapy? ›

A quick reminder: the success rate across the board of psychotherapies is embarrassingly low (10%–30%).

What are the two most common problems that lead to psychotherapy? ›

Research Methods. As per Olson and Marcus, 2010, two of the most prevalent mental health disorders for which people come to seek psychotherapy are anxiety and depression.

Why is it so hard to get a therapist right now? ›

Experts say a variety of obstacles stand in the way of those seeking mental health support, including a shortage of therapists, especially therapists of color, a lack of awareness among primary care doctors about available services, and hard-to-navigate websites.

What is the success rate of psychotherapy? ›

About 75 percent of people who enter psychotherapy show some benefit from it. Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction.

Why I quit psychotherapy? ›

The authors note some reasons why patients drop out: They are unwilling to open up about themselves; they cannot agree with the therapist about what the problem is; they just don't get along with or feel confidence in the therapist; they believe they are not improving quickly enough; they have unrealistic expectations.

What are the negatives of psychotherapy? ›

The emergence of new symptoms, which includes the development of interpersonal difficulties or issues within the family or at work are possible signs of a negative impact of psychotherapy. Furthermore, the negative impact of psychotherapy may cause a significant decline or deterioration in existing symptoms.

What is the most controversial type of psychotherapy? ›

Aversion therapy is controversial

Because aversion therapy involves the use of unpleasant stimuli, it's quite controversial. Some therapists think it's unethical because it uses punishment as a therapeutic tool.

What is the most important factor in the success of psychotherapy? ›

The most important aspect of effective therapy is that the patient and the therapist work together to help the patient reach their goals in therapy. Q. Some therapists consistently produce better outcomes than others, regardless of treatment and patient characteristics.

What conditions are best treated with psychotherapy? ›

Psychotherapy can be helpful in treating most mental health problems, including:
  • Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder or post-traumatic stress disorder (PTSD)
  • Mood disorders, such as depression or bipolar disorder.
Mar 17, 2016

Is there a psychotherapist shortage? ›

However, another side effect of the pandemic is a therapist shortage. The demand for therapy has gone up, and the number of people available to talk with has gone down.

Why does therapy not work sometimes? ›

Reasons, such as lack of trust or feeling misunderstood, may make you feel like therapy isn't helping. Here's how you can improve your experience. There are many reasons why therapy may not be working for you. Your therapist, the type of therapy they provide, and how they relate to you may be the reasons.

How can I get better if I can't get therapy? ›

“There are several options to consider when you can't afford therapy. Asking a therapist for a sliding scale or pro bono services, applying for services at a local community center, checking if your employer offers an employee assistance program, and checking online services are some of the options.”

Which type of psychotherapy is the most effective? ›

The most robustly studied, best-understood, and most-used is cognitive behavioral therapy. Other effective therapies include light therapy, hypnosis, and mindfulness-based treatments, among others.

How quickly does psychotherapy work? ›

So how long does it typically take for treatment to work? Recent research indicates that on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures.

Is a psychotherapist as good as a psychologist? ›

They're more similar than they are different. However, you're more likely to find a clinical psychologist working in a hospital setting than a counselling psychologist. Both are well-equipped to treat a wide-range of mental health issues including anxiety and depression.

What is the dropout rate for psychotherapy? ›

Studies show that 20-57% of individuals do not return to therapy after their initial appointment. There are various reasons for this, and for premature dropout rate in general.

How do you know when to stop psychotherapy? ›

Signs You May Be Ready to End Therapy
  • You accomplished the goals that you set when you began. ...
  • You've reached a plateau. ...
  • You don't have anything to talk about. ...
  • Your needs have changed throughout the course of therapy.
Mar 4, 2022

What percentage of clients drop out of therapy? ›

Depending on which study you read, between 20 and 57% of therapy clients do not return after their initial session. Another 37 to 45% only attend therapy a total of two times. Although many factors contribute to premature client termination, the number one cited reason by clients is dissatisfaction with the therapist.

What are some of the limits of psychotherapy? ›

Other disadvantages include:
  • Strategies can seem superficial, failing to address the "real" problem.
  • CBT includes homework and effort from you outside of the therapist's office, which some people do not want to do.
  • Some people feel they are being talked out of emotions and are expected to use logic too often.
Jun 12, 2020

What percent of clients get worse from therapy? ›

Anywhere from 50 to 75 percent of people who go to therapy report some benefit—but at least 5 percent of clients get worse as a result of treatment. (For people from marginalized groups, harmful outcomes may be even more common.)

Does psychotherapy affect the brain? ›

Psychotherapy leads to measurable functional changes in the brain. These changes depend on the psychiatric disorder. These changes depend on the type of psychotherapy. These changes depend on the patient's clinical response.

Who are the most difficult clients for therapists to work with? ›

Types of difficult clients in therapy
  • Clients who've been forced into therapy by others. ...
  • Clients who are argumentative. ...
  • Clients who need emergency help. ...
  • Clients who think their therapist is fully responsible for their wellness. ...
  • Clients who cross boundaries.

What is the difference between a psychotherapist and a regular therapist? ›

A psychotherapist includes all professionals who deal with mental health problems or emotional issues, whereas a therapist provides therapy solutions in various fields. A psychotherapist is a broader term that includes all professionals who deal with the management of mental health problems or emotional issues.

Who is the most famous psychotherapist? ›

1. Albert Bandura. The most cited counseling psychologist alive is Albert Bandura, a David Starr Jordan Professor Emeritus of Social Science in Psychology at Stanford University.

What are the three goals of psychotherapy? ›

Adjusting to injury or medical conditions. Dealing with difficult life decisions. Developing social skills. Focusing on wellness and personal growth.

What are the three common ingredients of effective psychotherapy? ›

Rogers (1951) defines what he considered to be the active components in the therapeutic relationship: empathy, congruence, and unconditional positive regard.

Which kind of clients is considered best for psychotherapy? ›

Psychotherapy can be helpful for people who are experiencing a mental health problem, but it can also be beneficial for people interested in learning new coping strategies or better understanding their own thoughts and experiences.

Can psychotherapists diagnose? ›

A registered psychotherapist is not able to diagnose, nor prescribe medication. They are able to conduct assessments and provide treatment (aka therapy).

What state has the highest demand for therapists? ›

The Best States for Psychologists: Job Demand
  • California.
  • New York.
  • Pennsylvania.
  • Ohio.
  • Texas.
Aug 25, 2022

Is it hard to become a psychotherapist? ›

Training in psychotherapy is personally and emotionally challenging. It can also be costly and takes a lot of time and dedication. It's important to think about how it will impact your life before committing to a course.

Is psychotherapy on the rise? ›

The percentage of adults getting mental health treatment increased from 19.2% in 2019 to 21.6% in 2021, the Centers for Disease Control and Prevention reported in data published this month.

What to do if psychotherapy doesn't work? ›

Ask Your Therapist About Next Steps

If therapy isn't working, the first person you should talk to is your therapist. She may opt to change her approach to treatment, pursue more “homework” options for you, or even refer you to another therapist.

How can I tell if therapy is working? ›

6 Progress-in-Therapy Indicators
  • Your moods and emotions have improved. Depending on the reasons for entering therapy, check if any of your symptoms have improved. ...
  • Your thinking has shifted. ...
  • Your behaviors have changed. ...
  • Your relationships with others are better. ...
  • You have better life satisfaction. ...
  • Your diagnosis changes.
Jan 24, 2017

Is therapy every week too much? ›

First off, evidence-based research studies generally show an association between weekly psychotherapy sessions and positive outcomes for clients. This appears to be especially important in the first stage of therapy, when you're building rapport with your therapist and beginning to get to the core of things.

Do some people need therapy forever? ›

Your relationship with a therapist can be one of the most meaningful, insightful, and productive collaborations you'll have in your life. But it should ultimately come to an end — and that's by design. “Therapy isn't supposed to be forever,” says licensed therapist Keir Gaines. “There is an endpoint.”

Do you ever stop needing therapy? ›

But for most people, there will come a time when therapy no longer feels necessary or progress has stalled. In most cases, the client will choose to end therapy; there are also situations in which a therapist decides to end sessions and refer a client elsewhere. Formally, ending therapy is called “termination.”

What therapy has the most evidence? ›

Since cognitive-behavioral therapy (CBT) is one of the strongest evidence-based therapies out there, it is important to include a book that discusses CBT specifically. This book discusses the literature surrounding CBT and also how to incorporate these findings into a clinical practice.

What is the most common psychotherapy approach today? ›

Cognitive behavioral therapy, or CBT, is the “most common type of therapy, no doubt,” says Johnsen.

Which psychotherapy has the strongest evidence for treating depression? ›

Cognitive behavioral therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder.

How long should you go to psychotherapy? ›

The number of recommended sessions varies by condition and treatment type, however, the majority of psychotherapy clients report feeling better after 3 months; those with depression and anxiety experience significant improvement after short and longer time frames, 1-2 months & 3-4.

How effective is psychotherapy as a whole? ›

How effective is psychotherapy? Hundreds of studies have found that psychotherapy helps people make positive changes in their lives. Reviews of these studies show that about 75% of people who enter psychotherapy show some benefit.

Which is better counselling or psychotherapy? ›

A counsellor is more likely to help with a specific difficulty, current problem or surface issue. An example might include a bereavement or a difficulty that is not necessarily rooted in the past. A psychotherapist is more likely to help with more deep-rooted difficulties that affects a client's life.

Do psychotherapists treat anxiety? ›

Psychologists are trained in diagnosing anxiety disorders and teaching patients healthier, more effective ways to cope. A form of psychotherapy known as cognitive-behavioral therapy (CBT) is highly effective at treating anxiety disorders.

Can a psychotherapist help with anxiety? ›

Psychotherapy. Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety. Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders.

Is psychotherapy less effective than medication? ›

Research generally shows that psychotherapy is more effective than medications, and that adding medications does not significantly improve outcomes from psychotherapy alone.

Can you measure the effectiveness of psychotherapy? ›


Developing a technology for meas- uring outcomes is the first step in determining psychotherapy's efficacy. It involves decisions about what variables are important to assess, as well as the development of measurement tech- niques that can be used in actual treatment set- tings.

Is psychotherapy effective long term? ›

There is extensive evidence demonstrating that psychotherapy can be an efficacious and effective health care service for a wide range of commonly experienced mental health and health conditions.

Does psychotherapy get worse before it gets better? ›

It is actually normal to occasionally feel bad or worse after therapy, especially during the beginning of your work with a therapist. It can be a sign of progress. As counterintuitive as it may sound, feeling bad during therapy can be good.

When should a psychotherapist be terminated? ›

Moving Toward Termination of Therapy. Ideally, termination occurs when the goals that are mutually agreed upon by the counselor and client have been achieved, or the problem for which a client has entered into counseling has become more manageable or is resolved.

Which psychotherapy is most effective? ›

The most robustly studied, best-understood, and most-used is cognitive behavioral therapy. Other effective therapies include light therapy, hypnosis, and mindfulness-based treatments, among others.

What is the most important factor in psychotherapy? ›

The most important aspect of effective therapy is that the patient and the therapist work together to help the patient reach their goals in therapy.

How long does it take to see results from psychotherapy? ›

The number of recommended sessions varies by condition and treatment type, however, the majority of psychotherapy clients report feeling better after 3 months; those with depression and anxiety experience significant improvement after short and longer time frames, 1-2 months & 3-4.

Does psychotherapy change the brain? ›

Psychotherapy changes gene expression. Psychotherapy produces long-term changes in behavior, by producing changes in gene expression that alter the strength of synaptic connections and structural changes that alter the anatomical pattern of interconnections between nerve cells of the brain.

Why is psychotherapy better than medication? ›

Unlike with the potential of some psychotropic medications, psychotherapy is not addictive. Furthermore, some studies have shown that Cognitive Behavioral Therapy can be more effective at relieving anxiety and depression than medication.

What's the difference between a psychotherapist and a therapist? ›

A psychotherapist includes all professionals who deal with mental health problems or emotional issues, whereas a therapist provides therapy solutions in various fields. A psychotherapist is a broader term that includes all professionals who deal with the management of mental health problems or emotional issues.


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