The Evidence on Talk Therapy, Without the Hype

Key takeaways

• Ways to find a therapist: your doctor, your insurance plan's directory, an employee assistance program, or FindTreatment.gov
• Well-studied for anxiety and depression: cognitive behavioral therapy (CBT)
• Most useful single change: Ask your doctor for a referral, or contact therapists in your insurance network directly.
• Commonest mistake: Assuming you cannot find therapy without a referral.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

Structured psychological treatments, also called psychotherapy, such as CBT, counseling and guided self-help. It sits within Mental Health. Here are the numbers, taken from the guidance cited at the end.

The numbers, in one place

What helps

These are worth doing. None of them needs to happen all at once.

• Ask your doctor for a referral, or contact therapists in your insurance network directly
• Do the between-session work, which is where most of the change happens
• Say early if the approach is not fitting; it can be changed
• Ask your insurer about copays and session limits before you start

What to avoid

The usual wrong turns. Some are more tempting than others.

• Assuming you cannot find therapy without a referral
• Stopping after one difficult session
• Treating therapy and medication as mutually exclusive

In depth

Talk therapy, or psychotherapy, is a structured way of working with a trained professional to understand and change patterns of thinking, feeling and behavior. It is different from an ordinary supportive conversation: sessions have a clear focus, the therapist uses techniques with an evidence base, and you usually agree on goals at the start. Therapy is a core treatment for many conditions, including depression, anxiety disorders, post-traumatic stress disorder, eating disorders and insomnia.

There are many types. Cognitive behavioral therapy looks at how thoughts, feelings and behaviors influence each other and teaches practical skills. Interpersonal therapy focuses on relationships and life changes. Dialectical behavior therapy helps with intense emotions and self-harm. Psychodynamic therapy explores how past experiences shape current patterns. Some approaches, such as exposure therapy or CBT for insomnia, target a specific problem. Different conditions respond best to different approaches.

In the US, therapy is provided by several kinds of licensed professionals, including psychologists, licensed clinical social workers, licensed professional counselors and marriage and family therapists, as well as psychiatrists, who are medical doctors. Insurance coverage, cost and waiting times vary widely. Knowing how to navigate the options, and what to expect once you start, makes it more likely you will find help that works and stick with it.

Signs and symptoms

• Low mood, worry or stress that has lasted for weeks and affects daily life
• Repeating patterns in relationships that you want to change
• Difficulty coping after a loss, trauma or major life change
• Sleep problems that have not improved with simple changes
• Using alcohol, food or other habits to manage difficult feelings
• A doctor recommending therapy as part of treatment

Causes and risk factors

• The match between the type of therapy and the problem being treated
• The working relationship with your therapist
• How regularly you attend and whether you practice between sessions
• Insurance coverage, cost and how easy it is to attend
• Whether other problems, such as substance use, are also addressed

How it is checked

The first session or two are usually an assessment. The therapist asks about your current difficulties, history, health, relationships and goals, and may use questionnaires to measure symptoms. This helps them understand what is going on, suggest an approach and agree on a plan with you. It is also your chance to ask questions and judge whether you feel comfortable working with them.

If you start with your primary care doctor, they can assess your symptoms, check for physical causes and refer you to a therapist or psychiatrist. Your insurance plan may require a referral or pre-authorization, so it is worth checking before you book. Many therapists also offer a brief phone call before the first session to discuss fit.

Treatment and support options

Cognitive behavioral therapy

CBT is structured, time-limited and focused on the present. You and your therapist identify unhelpful thoughts and behaviors and work on alternatives, often with homework between sessions. It is well studied for anxiety and depression and adapted versions exist for insomnia, panic, obsessive-compulsive disorder, trauma and chronic pain.

Other evidence-based therapies

Interpersonal therapy is effective for depression, especially when linked to relationships or life transitions. Dialectical behavior therapy helps people with intense emotions and self-harm. Trauma-focused therapies help with PTSD. Your doctor or therapist can explain which approach best fits your situation, and it is reasonable to ask what evidence supports the approach being offered.

Telehealth and digital therapy

Many therapists now offer sessions by video or phone, which can save travel time and widen your choice. Digital CBT programs with some clinician support are also available for common problems. Check that the provider is licensed in your state and that your insurance covers telehealth sessions.

Low-cost and free options

If cost is a barrier, consider community mental health centers, sliding-scale clinics, university training clinics and employee assistance programs. FindTreatment.gov and the SAMHSA National Helpline can help locate services. Medicaid covers mental health care in every state, though the details vary.

Prevention

• Check your insurance network and costs before booking
• Prepare for each session by noting what you want to discuss
• Complete agreed tasks between sessions
• Tell your therapist if something is not working
• Plan with your therapist how to maintain progress after therapy ends

Day to day

Therapy works best when you treat it as active work rather than something done to you. Bring specific situations to discuss, be as honest as you can, and try out the skills between sessions even when they feel awkward. Progress is often uneven: some sessions feel productive and others feel stuck or emotionally difficult, which is normal.

Keep track of your goals and review them with your therapist every few sessions. If you are not seeing any change after several weeks, raise it; the approach can be adjusted, or a different therapist may be a better fit. Toward the end of therapy, plan how you will keep using what you have learned and what you will do if problems return.

For specific groups

Children and teens

Therapy for young people often involves parents or caregivers, who learn how to support new skills at home. Schools may have counselors and can sometimes help with referrals. Ask your child's doctor for recommendations.

Medicare beneficiaries

Medicare Part B covers outpatient mental health services, including therapy from several types of licensed professionals, and telehealth options. Costs such as copays and deductibles apply. Check with Medicare or your plan for details.

Veterans

The Department of Veterans Affairs provides mental health care, including evidence-based therapies for PTSD and depression. Veterans can call 988 and press 1 to reach the Veterans Crisis Line.

Questions to ask your doctor

• What type of therapy would be most helpful for my symptoms?
• Can you refer me to a therapist, and does my insurance require a referral?
• Should I also consider medication alongside therapy?
• How many sessions might I need?
• What should I do if I am on a waitlist and my symptoms get worse?
• Are there telehealth or digital options I could start with?

More questions, answered

How do I know if a therapist is right for me?

You should feel respected, listened to and able to be honest, even if some topics are uncomfortable. A good therapist explains their approach, agrees on goals with you and checks your progress. If after a few sessions you do not feel comfortable, it is fine to look for someone else.

What is the difference between a psychologist and a psychiatrist?

Psychiatrists are medical doctors who can diagnose mental health conditions and prescribe medication; many focus mainly on medication management. Psychologists have doctoral training in psychology and provide assessment and therapy. Licensed social workers and counselors also provide therapy.

Is therapy confidential?

Therapists are bound by confidentiality laws and professional ethics. There are limits, such as when someone is at serious risk of harm or when the law requires reporting, for example child abuse. Your therapist should explain these limits at the start.

How long does therapy take?

It varies. Structured therapies such as CBT often involve a limited number of weekly sessions over a few months. Other approaches may be longer-term. Your therapist should give you an idea of expected length after the assessment.

Can therapy make me feel worse before better?

Discussing difficult experiences or facing feared situations can bring up strong feelings temporarily. This is often part of the process. Tell your therapist if you feel overwhelmed; they can adjust the pace. If you have thoughts of harming yourself, call or text 988.

Does insurance have to cover therapy?

Under federal mental health parity law, most health plans that cover mental health care must not make it harder to access than medical care, for example through stricter limits or higher copays. Coverage still varies, so check your plan's network, copays and any session limits.

Related topics

• Psychological Therapies for Pain: What Published Guidance Supports (Chronic Pain)
• Physical Therapy: Sorting the Evidence From the Noise (Back and Posture)
• Physical Therapy Services: Sorting the Evidence From the Noise (Rehabilitation)
• What the Guidance Really Says About Insomnia (Sleep)

Where to go next

• Talk Therapy in Five Minutes
• Understanding Talk Therapy: A Plain-English Explainer
• Talk Therapy — the reference entry
• Mental Health: The Complete Guide
• The Evidence on Screen Time and Mood, Without the Hype
• Supporting Someone Else: What the Evidence Actually Says

When to speak to a doctor

See your doctor urgently if symptoms are severe or you have psychotic symptoms such as hearing voices. If you feel unable to keep yourself safe or have thoughts of harming yourself, call or text 988 at any hour. In immediate danger, call 911 or go to the nearest emergency room.

Where this comes from

• National Institute of Mental Health — Psychotherapies
• SAMHSA — National Helpline

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.