Someone might seek out psychotherapy for different reasons:
- You might be dealing with severe or long-term stress from a job or family situation, the loss of a loved one, or relationship or other family issues. Or you may have symptoms with no physical explanation: changes in sleep or appetite, low energy, a lack of interest or pleasure in activities that you once enjoyed, persistent irritability, or a sense of discouragement or hopelessness that won’t go away.
- A health professional may suspect or have diagnosed a condition such as depression, bipolar disorder, post-traumatic stress or other disorder and recommended psychotherapy as a first treatment or to go along with medication.
- You may be seeking treatment for a family member or child who has been diagnosed with a condition affecting mental health and for whom a health professional has recommended treatment.
An exam by your primary care practitioner can ensure there is nothing in your overall health that would explain your or a loved one’s symptoms.
Therapists have different professional backgrounds and specialties.There are resources at the end of this material that can help you find out about the different credentials of therapists and resources for locating therapists.
There are many different types of psychotherapy. Different therapies are often variations on an established approach, such as cognitive behavioral therapy. There is no formal approval process for psychotherapies as there is for the use of medications in medicine. For many therapies, however, research involving large numbers of patients has provided evidence that treatment is effective for specific disorders. These “evidence-based therapies” have been shown in research to reduce symptoms of depression, anxiety, and other disorders.
The particular approach a therapist uses depends on the condition being treated and the training and experience of the therapist. Also, therapists may combine and adapt elements of different approaches. The health information pages for specific disorders on the NIMH website list some of the evidence based therapies for those disorders.
One goal of establishing an evidence base for psychotherapies is to prevent situations in which a person receives therapy for months or years with no benefit. If you have been in therapy and feel you are not getting better, talk to your therapist, or look into other practitioners or approaches. The object of therapy is to gain relief from symptoms and improve quality of life.
Once you have identified one or more possible therapists, a preliminary conversation with a therapist can help you get an idea of how treatment will proceed and whether you feel comfortable with the therapist. Rapport and trust are important. Discussions in therapy are deeply personal and it’s important that you feel comfortable and trusting with the therapist and have confidence in his or her expertise. Consider asking the following questions:
- What are the credentials and experience of the therapist? Does he or she have a specialty?
- What approach will the therapist take to help you? Does he or she practice a particular type of therapy? What can the therapist tell you about the rationale for the therapy and the evidence base?
- Does the therapist have experience in diagnosing and treating the age group (for example, a child) and the specific condition for which treatment is being sought? If a child is
the patient, how will parents be involved in treatment?
- What are the goals of therapy? Does the therapist recommend a specific time frame or
numberof sessions? How will progress be assessed and what happens if you (or the therapist) feel you aren’t starting to feel better?
- Will there be homework?
- Are medications an option? How will medications be prescribed if the therapist is not an M.D.?
- Are our meetings confidential? How can this be assured?
If you are interested in reading more about evidence based therapies, see the links at the end of this material.
Psychotherapies and Other Treatment Options
Psychotherapy can be an alternative to medication or can be used along with other treatment options, such as medications. Choosing the right treatment plan should be based on a person’s individual needs and medical situation and under a mental health professional’s care.
Even when medications relieve symptoms, psychotherapy and other interventions can help a person address specific issues. These might include self-defeating ways of thinking, fears, problems with interactions with other people, or dealing with situations at home and at school or with employment.
Elements of Psychotherapy
A variety of different kinds of psychotherapies and interventions have been shown to be effective for specific disorders. Psychotherapists may use one primary approach, or incorporate different elements depending on their training, the condition being treated, and the needs of the person receiving treatment.
Here are examples of the elements that psychotherapies can include:
- Helping a person become aware of ways of thinking that may be automatic but are inaccurate and harmful. (An example might be someone who has a low opinion of his or her own abilities.) The therapist helps the person find ways to question these thoughts, understand how they affect emotions and behavior, and try ways to change self-defeating patterns. This approach is central to cognitive behavioral therapy (CBT).
- Identifying ways to cope with stress.
- Examining in depth a person’s interactions with others and offering guidance with social and communication skills, if needed.
- Relaxation and mindfulness techniques.
- Exposure therapy for people with anxiety disorders. In exposure therapy, a person spends brief periods, in a supportive environment, learning to tolerate the distress certain items, ideas, or imagined scenes cause. Over time the fear associated with these things dissipates.
- Tracking emotions and activities and the impact of each on the other.
- Safety planning can include helping a person recognize warning signs, and thinking about coping strategies, such as contacting friends, family, or emergency personnel.
- Supportive counseling to help a person explore troubling issues and provide emotional support.
The telephone, Internet, and mobile devices have opened up new possibilities for providing interventions that can reach people in areas where mental health professionals may be not be easily available, and can be at hand 24/7. Some of these approaches involve a therapist providing help at a distance, but others—such as web-based programs and cell phone apps— are designed to provide information and feedback in the absence of a therapist. For an overview, see our fact sheet on Technology and the Future of Mental Health Treatment.
Some approaches that use electronic media to provide help for mental health-related conditions have been shown by research to be helpful in some situations, others not as yet. The American Psychological Association has information to consider before choosing online therapy .
It is important to note that, as with all care for conditions affecting mental health, the treatment needs to be appropriate for the condition and the individual. eHealth approaches may be helpful in some situations, including as a support with other in-person treatment, but may not be appropriate or effective as a substitute for in-person care.
There is as yet no central resource for information on the effectiveness of health apps. The following links have information on health information technology in general:
- Health IT: How to Keep Your Health Information Private and Secure from the Department of Health and Human Services
- Understanding Mobile Apps from OnGuardOnline.gov
- Information on mobile medical applications from the Food and Drug Administration
If you are interested in using a mobile app, read the accompanying information, including whether and how the app has been tested. If you are working with a therapist, consult with him or her for help in evaluating the app.
The symptoms of mental disorders can have a profound effect on someone’s quality of life and ability to function. Treatment can address symptoms as well as assist someone experiencing severe or ongoing stress. Some of the reasons that you might consider seeking out psychotherapy include:
- Overwhelming sadness or helplessness that doesn’t go away
- Serious, unusual insomnia or sleeping too much
- Difficulty focusing on work, or carrying out other everyday activities
- Constant worry and anxiety
- Drinking to excess or any behavior that harms self or others
- Dealing with a difficult transition, such as a divorce, children leaving home, job difficulties, or the death of someone close
- Children’s behavior problems that interfere with school, family, or peers
Seeking help is not an admission of weakness, but a step towards understanding and obtaining relief from distressing symptoms.
Many different professionals offer psychotherapy. Examples include psychiatrists, psychologists, social workers, counselors, and psychiatric nurses. Information on the credentials of providers is available from the National Alliance on Mental Illness . Resources to help find a practitioner are listed on the Help for Mental Illnesses page on the NIMH website.
Your health plan may have a list of mental health practitioners who participate in the plan. Other resources on the “Help for Mental Illnesses” page can help you look for reduced cost health services. The resources listed there include links to help find reduced cost treatment. When talking with a prospective therapist, ask about treatment fees, whether the therapist participates in insurance plans, and whether there is a sliding scale for fees according to income.
The following professional organizations have directories or locators on their websites for mental health care practitioners (Note: This list is not comprehensive and does not constitute an endorsement by NIMH):
National advocacy organizations have information on finding a mental health professional and sometimes practitioner locators on their websites. Examples include:
Please note: NIMH does not evaluate the professional qualifications and competence of individual practitioners listed on these websites. The resources are provided for general informational purposes only and do not constitute an endorsement by NIMH.
University or medical school-affiliated programs may offer treatment options. Search on the website of local university health centers for their psychiatry or psychology departments.
You can also go to the website of your state or county government and search for the health department for information on mental health-related programs within your state.
An article from the National Institute of Mental Health