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Understanding psychotherapy and how it

works
Learn how to choose a psychologist, how therapy works, how long it lasts, and what
should and shouldn’t happen during psychotherapy

Last updated: December 12, 2023 Date created: November 1, 2012 32 min read

Psychotherapy

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Do you ever feel too overwhelmed to deal with your problems? If so,
you’re not alone.

According to the National Institute of Mental Health

(http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml) , more than a
:
 quarter of American adults experience depression, anxiety, or another
mental disorder in any given year. Others need help coping with a
serious illness, losing weight, or stopping smoking. Still others
struggle to cope with relationship troubles, job loss, the death of a
loved one, stress, substance abuse, or other issues. And these
problems can often become debilitating.

What is psychotherapy?
A psychologist can help you work through such problems. Through
psychotherapy, psychologists help people of all ages live happier,
healthier, and more productive lives.

In psychotherapy, psychologists apply scientifically validated

procedures to help people develop healthier, more effective habits.
There are several approaches to psychotherapy—including cognitive-
behavioral, interpersonal, and other kinds of talk therapy—that help
individuals work through their problems.

Psychotherapy is a collaborative treatment based on the relationship

between an individual and a psychologist. Grounded in dialogue, it
provides a supportive environment that allows you to talk openly with
someone who’s objective, neutral, and nonjudgmental. You and your
psychologist will work together to identify and change the thought
and behavior patterns that are keeping you from feeling your best.

By the time you’re done, you will not only have solved the problem
that brought you in, but you will have learned new skills so you can
better cope with whatever challenges arise in the future.

When should you consider psychotherapy?

Because of the many misconceptions about psychotherapy
(/topics/psychotherapy/myths) , you may be reluctant to try it out. Even
if you know the realities instead of the myths, you may feel nervous
about trying it yourself.

Overcoming that nervousness is worth

it. That’s because any time your quality
of life isn’t what you want it to be,
psychotherapy can help.

Some people seek psychotherapy because they have felt depressed,

anxious, or angry for a long time. Others may want help for a chronic
illness that is interfering with their emotional or physical well-being.
Still others may have short-term problems they need help navigating.
They may be going through a divorce, facing an empty nest, feeling
overwhelmed by a new job, or grieving a family member’s death, for
example.

Signs that you could benefit from therapy include:

:
 You feel an overwhelming, prolonged sense of helplessness and
sadness

Your problems don’t seem to get better despite your efforts and
help from family and friends

You find it difficult to concentrate on work assignments or to

carry out other everyday activities

You worry excessively, expect the worst, or are constantly on

edge

Your actions, such as drinking too much alcohol, using drugs, or

being aggressive, are harming you or others

What are the different kinds of

psychotherapy?
There are many different approaches to psychotherapy. Psychologists
generally draw on one or more of these. Each theoretical perspective
acts as a roadmap to help the psychologist understand their patients
and their problems and develop solutions.

The kind of treatment you receive will depend on a variety of factors:

current psychological research, your psychologist’s theoretical
orientation, and what works best for your situation.

Your psychologist’s theoretical perspective will affect what goes on in

his or her office. Psychologists who use cognitive-behavioral therapy,
for example, have a practical approach to treatment. Your
psychologist might ask you to tackle certain tasks designed to help
you develop more effective coping skills. This approach often involves
homework assignments.

Your psychologist might ask you to gather more information, such as

logging your reactions to a particular situation as they occur. Or your
psychologist might want you to practice new skills between sessions,
such as asking someone with an elevator phobia to practice pushing
elevator buttons. You might also have reading assignments so you can
learn more about a particular topic.

In contrast, psychoanalytic and humanistic approaches typically focus

more on talking than doing. You might spend your sessions discussing
your early experiences to help you and your psychologist better
understand the root causes of your current problems.

Your psychologist may combine elements from several styles of

psychotherapy. In fact, most therapists don’t tie themselves to any
one approach. Instead, they blend elements from different approaches
and tailor their treatment according to each patient’s needs.

The main thing to know is whether your psychologist has expertise in

the area you need help with and whether your psychologist feels he or
:
 she can help you.

Finding a psychologist
Once you’ve decided to try psychotherapy, you need to find a
psychologist.

Why choose a psychologist for

psychotherapy?
Psychologists who specialize in psychotherapy and other forms of
psychological treatment are highly trained professionals with
expertise in mental health assessment, diagnosis, and treatment, and
behavior change.

After graduating from a four-year undergraduate college or university,

psychologists spend an average of seven years in graduate education
and training to earn a doctoral degree. That degree may be a PhD,
PsyD or EdD.

As part of their professional training,

psychologists must complete a
supervised clinical internship in a
hospital or organized health setting. In
most states, they must also have an
additional year of post-doctoral supervised experience before they
can practice independently in any health care arena. It is this
combination of doctoral-level training and clinical internship that
distinguishes psychologists from many other mental health care
providers.

Psychologists pass a national examination and must be licensed by

the state or jurisdiction in which they practice. Licensure laws are
intended to protect the public by limiting licensure to those who are
qualified to practice psychology as defined by state law. Most states
also require psychologists to stay up-to-date by earning several hours
of continuing education credits annually.

In addition, APA members adhere to a strict code of professional

ethics.

How do I find a psychologist?

If you plan to use your insurance or employee assistance program to

pay for psychotherapy, you may need to select a psychologist who is

part of your insurance plan or employee assistance program. But if
you’re free to choose, there are many ways to find a psychologist:

Ask trusted family members and friends.

Ask your primary care physician, obstetrician/gynecologist,

pediatrician, or another health professional. If you’re involved in a
divorce or other legal matters, your attorney may also be able to
:
 divorce or other legal matters, your attorney may also be able to
provide referrals.

Search online for psychologists’ websites.

Contact your area community mental health center.

Consult a local university or college department of psychology.

Call your local or state psychological association

(/about/apa/organizations/associations) , which may have a list of
practicing psychologists organized by geographic area or
specialty.

Or use a trusted online directory, such as APA’s Psychologist Locator

service (http://locator.apa.org/) . This service makes it easy for you to
find practicing psychologists in your area.

Psychologists may work in their own private practice or with a group

of other psychologists or health care professionals. Practicing
psychologists also work in schools, colleges and universities,
hospitals, health systems and health management organizations,
veterans’ medical centers, community health and mental health
clinics, businesses and industry, and rehabilitation and long-term care
centers.

Selecting a psychologist
APA estimates that there are about 85,000 licensed psychologists in
the United States. How can you find the one who’s right for you?

Psychologists and patients work together, so the right match is

important. Good “chemistry” with your psychologist is critical, so
don’t be afraid to interview potential candidates about their training,
clinical expertise, and experience treating problems like yours.
Whether you interview a psychologist by phone, during a special 15-
minute consultation, or at your first session, look for someone who
makes you feel comfortable and inspires confidence.

But it’s also important to check more practical matters, too.

What should you ask yourself ?

When you’re ready to select a psychologist, think about the following
points:

Do you want to do psychotherapy by yourself, with your partner

or spouse, or with your children?

What are your main goals for psychotherapy?

Will you use your health insurance or employee assistance

program to pay for psychotherapy?

If you’ll be paying out of pocket, how much can you afford?

How far are you willing to drive?

:
 What days and times would be convenient?

What should you ask a psychologist?

You’ll need to gather some information from the psychologists whose
names you have gathered.

The best way to make initial contact with a psychologist is by phone.

While you may be tempted to use email, it’s less secure than the
telephone when it comes to confidentiality. A psychologist will
probably call you back anyway. And it’s faster for everyone to talk
rather than have to write everything down.

Psychologists are often with patients and don’t always answer their
phones right away. Just leave a message with your name, phone
number, and brief description of your situation.

Once you connect, some questions you can ask a psychologist are:

Are you accepting new patients?

Do you work with men, women, children, teens, couples, or

families? (Whatever group you are looking for.)

Are you a licensed psychologist in the state where I live?

How many years have you been practicing?

What are your areas of expertise?

Do you have experience helping people with symptoms or

problems like mine?

What is your approach to treatment? Have the treatments you

use been proven effective for dealing with my problem?

What are your fees? Do you have a sliding-scale policy if I can’t

afford your regular fees? Do you accept credit cards or personal
checks? Do you expect payment at the time of service?

Do you accept my insurance? Are you affiliated with any

managed care organizations? Do you accept Medicare or
Medicaid?

Will you accept direct billing to or payment from my insurance

company?

What are your policies concerning things like missed

appointments?

If you have particular concerns that are deal-breakers for you, ask the
psychologist about them. You might want to work with a psychologist
who shares your religious views or cultural background, for example.
While some psychologists are more open to disclosing personal
information than others, the response will give you important

information about whether you’ll work well together.

While you’re assessing a psychologist, he or she will also be assessing

:
 While you’re assessing a psychologist, he or she will also be assessing
you. To ensure that psychotherapy is successful, the psychologist
must determine whether there’s a good match when it comes to
personality as well as professional expertise. If the psychologist feels
the fit isn’t right—perhaps because you need someone with a different
specialty area—he or she will refer you to another psychologist who
can help.

Getting started
How can I pay for psychotherapy?
If you have private health insurance or are enrolled in a health
maintenance organization or other type of managed care plan, it may
cover mental health services such as psychotherapy. Before you start
psychotherapy, you should check with your insurance plan to see
what is covered.

Thanks to the Paul Wellstone and Pete Domenici Mental Health Parity
and Addiction Equity Act of 2008 (/topics/managed-care-
insurance/parity-law-resources) , group insurers of more than 50
employees that offer mental health and substance use services must
cover both mental and physical health equally. That means insurers
are no longer allowed to charge higher copays or deductibles for
psychological services or arbitrarily limit the number of
psychotherapy sessions you can receive.

However, insurance companies vary in terms of which mental health

conditions they cover. That means some insurance policies may not
cover certain mental health disorders.

Your employer may also offer an

employee assistance program. These
programs typically offer one to eight
sessions of mental health treatment for
free or at a very low cost. Your spouse or
partner may also be eligible for these benefits.

Government-sponsored health care programs are another potential

source of mental health services. These include Medicare for people
age 65 and older and people with disabilities, as well as health
insurance plans for military personnel and their dependents. In some
states, Medicaid programs may also cover mental health services
provided by psychologists.

Other options include community mental health centers, free clinics,

religious organizations, and university and medical center training
programs. These groups often offer high-quality services at low cost.

What should I ask my insurance company?

Look on the back of your insurance card for a phone number for
:
 mental or behavioral health or call your insurance company’s
customer service number. Before your first psychotherapy
appointment, ask your insurer the following questions:

Does my plan cover mental health services?

Do I have a choice about what kind of mental health professionals

I can see? Ask whether your plan covers psychologists and what
kinds of treatments are covered and excluded.

Is there a deductible? In some plans, you have to pay a certain

amount yourself before your benefits start paying. Also ask how
much the deductible is, what services count toward your
deductible and when your deductible amount starts over again.
Some deductibles re-set at the first of the year, for example, while
others re-set at the beginning of your employer’s fiscal year.

What is my copayment? Your plan probably requires you to pay

for part of treatment yourself by paying either a set amount or a
percentage of the fee directly to your psychologist for each
treatment session.

Is there a limit to the number of sessions? Unlike group or

employer-based insurance that must provide mental health
parity, private insurance does not. It may only be willing to pay for
a certain number of sessions.

Making your first appointment

You may feel nervous about contacting a psychologist. That anxiety is
perfectly normal. But having the courage to overcome that anxiety and
make a call is the first step in the process of empowering yourself to
feel better. Just making a plan to call and sticking to it can bring a
sense of relief and put you on a more positive path.

Psychologists understand how difficult it can be to make initial

contact. The first call is something new for you, but it’s something
they handle regularly. Leave a message with your name, your contact
number, and why you are calling. It’s enough to just say that you are
interested in knowing more about psychotherapy. Once your call is
returned, they’ll lead a brief conversation to get a better sense of what
you need, whether they are able to help, and when you can make an
appointment.

You might be tempted to take the first available appointment slot.

Take a few minutes to stop and think before you do. If it does not fit
with your schedule, you can ask if there are other times available that
might fit better for you.

What factors should you consider?

You’ll need to think about the best time of day and week to see your
psychologist. Factors to consider include:
:
 Your best time of day. Whether you’re a morning person or a
night owl, know when you’re at your best and schedule your
appointment accordingly.

Work. If you have to take time off from work, ask your human
resources department if you can use sick leave for your
psychotherapy sessions. You might also want to schedule your
first appointment later in the day so you don’t have to go back to
work afterward. If you have an upsetting topic to discuss, you
may be tired, emotionally spent, puffy-eyed, or distracted after
your first session.

Family responsibilities. Unless your children are participating in

treatment, it’s usually not a good idea to bring them along.
Choose a time when you will have child care available.

Other commitments. A psychotherapy session typically lasts 45

to 50 minutes. Try to schedule your session at a time when you
won’t have to rush to your next appointment afterward. Worrying
about being late to your next commitment will distract you from
your psychotherapy session.

How should I prepare for the appointment?

Once you’ve made an appointment, ask your psychologist how you
should prepare. A psychologist might ask you to:

Call your insurer to find out what your outpatient mental health
benefits cover, what your copay is, and whether you have a
deductible. If you don’t get this information ahead of time, your
psychologist may ask you to come to your appointment a little
early so he or she can help you verify your benefits.

Fill out new patient paperwork for your psychologist. Your

psychologist may have a website with forms you can download
and fill out before you arrive at your appointment. If not, you can
ask your psychologist to get you the forms and fill them out at
home rather than while sitting in the psychologist’s waiting room.
Your psychologist may also provide a packet of materials covering
logistical issues, such as cancellation fees and confidentiality.

Get records from other psychologists or health care providers

you’ve seen.

You may also want to prepare a list of questions, such as the

average treatment duration, the psychologist’s feelings about
medication, or good books on your issue.

Learn about therapy. If any of your friends have done

psychotherapy, ask them what it was like. Or read up on the
subject. If you’ve had psychotherapy before, think about what you
liked and didn’t like about your former psychologist’s approach.

Keep an open mind. Even if you’re skeptical about psychotherapy

or are just going because someone told you to, be willing to give it
a try. Be willing to be open and honest so you can take advantage
of this opportunity to learn more about yourself.
:
 Make sure you know where you’re going. Check the
psychologist’s website or do a map search for directions to the
psychologist’s office.

Going to your first appointment

It’s normal to feel nervous when you head off to your first
psychotherapy appointment. But preparing ahead of time and
knowing what to expect can help calm your nerves.

What should I bring?

A typical psychotherapy session lasts 45 to 50 minutes. To make the
most of your time, make a list of the points you want to cover in your
first session and what you want to work on in psychotherapy. Be
prepared to share information about what’s bringing you to the
psychologist. Even a vague idea of what you want to accomplish can
help you and your psychologist proceed efficiently and effectively.

If you’ve been referred by another

professional, such as a physician or
attorney, notes about why they did so
can be helpful. If a teacher suggested

that your child undergo psychotherapy,

you might bring in report cards or notes from his or her teacher. Your
psychologist can also call these professionals for additional
information if you give written permission. Records from previous
psychotherapy or psychological testing can also help your new
psychologist get a better sense of you.

If you’re on any medications, jot down which medications and what

dosage so your psychologist can have that information.

It can be difficult to remember everything that happens during a

psychotherapy session. A notebook can help you capture your
psychologist’s questions or suggestions and your own questions and
ideas. Jotting a few things down during your session can help you stay
engaged in the process.

Most people have more than a single session of psychotherapy. Bring

your calendar so you can schedule your next appointment before you
leave your psychologist’s office.

You’ll also need to bring some form of payment. If you’ll be using your
health insurance to cover your psychotherapy, bring along your
insurance card so your psychologist will be able to bill your insurer.
(Some insurers require psychologists to check photo IDs, so bring that
along, too.) If you’ll be paying for psychotherapy out of pocket, bring
along a credit card, checkbook, or cash.
:
 What should I expect?
For your first session, your psychologist may ask you to come in a little
early to fill out paperwork if you haven’t already done so.

Don’t worry that you won’t know what to do once the session actually
begins. It’s normal to feel a little anxious in the first few sessions.
Psychologists have experience setting the tone and getting things
started. They are trained to guide each session in effective ways to
help you get closer to your goals. In fact, the first session might seem
like a game of 20 questions.

Sitting face to face with you, your psychologist could start off by

acknowledging the courage it takes to start psychotherapy. He or she
may also go over logistical matters, such as fees, how to make or
cancel an appointment, and confidentiality, if he or she hasn’t already
done so by phone.

Then the psychologist may ask a

question like, “What brought you here
today?” or “What made you decide to
come in now rather than a month or a
year ago?” It helps to identify your
problem, even if you’re not sure why you have it or how to handle it.
For example, you might feel angry or sad without knowing what’s
causing your feelings or how to stop feeling that way. If the problem is
too painful to talk about, the psychologist shouldn’t push you to say
more than you’re comfortable sharing until you get to know each
other better. It’s OK for you to say that you are not ready to talk about
something just yet.

Your psychologist will also want to know about your own and your
family’s history of psychological problems such as depression, anxiety,
or similar issues. You’ll also explore how your problem is affecting
your everyday life. Your psychologist will ask questions like whether
you’ve noticed any changes in your sleeping habits, appetite or other
behaviors. A psychologist will also want to know what kind of social
support you have, so he or she will also ask about your family, friends
and coworkers.

It’s important not to rush this process, which may take more than one
session. While guiding you through the process, your psychologist will
let you set the pace when it comes to telling your story. As you gain
trust in your psychologist and the process, you may be willing to share
things you didn’t feel comfortable answering at first.

Once your psychologist has a full history, the two of you will work
together to create a treatment plan. This collaborative goal-setting is
important, because both of you need to be invested in achieving your
goals. Your psychologist may write down the goals and read them
back to you so you’re both clear about what you’ll be working on.
:
 back to you so you’re both clear about what you’ll be working on.
Some psychologists even create a treatment contract that lays out the
purpose of treatment, its expected duration, and goals, with both the
individual’s and psychologist’s responsibilities outlined.

At the end of your first session, the psychologist may also have
suggestions for immediate action. If you’re depressed, for example,
the psychologist might suggest seeing a physician to rule out any
underlying medical conditions, such as a thyroid disorder. If you have
chronic pain, you may need physical therapy, medication, and help for
insomnia as well as psychotherapy.

By the end of the first few sessions, you should have a new
understanding of your problem, a game plan, and a new sense of
hope.

Undergoing psychotherapy
Psychotherapy is often referred to as talk therapy, and that’s what
you’ll be doing as your treatment continues. You and your
psychologist will engage in a dialogue about your problems and how
to fix them.

What should I expect as I continue

psychotherapy?
As your psychotherapy goes on, you’ll continue the process of building
a trusting, therapeutic relationship with your psychologist.

As part of the ongoing getting-to-know-you process, your

psychologist may want to do some assessment. Psychologists are
trained to administer and interpret tests that can help to determine
the depth of your depression, identify important personality
characteristics, uncover unhealthy coping strategies such as drinking
problems, or identify learning disabilities.

If parents have brought in a bright child who’s nonetheless struggling

academically, for example, a psychologist might assess whether the
child has attention problems or an undetected learning disability. Test
results can help your psychologist diagnose a condition or provide
more information about the way you think, feel and behave.

You and your psychologist will also keep exploring your problems
through talking. For some people, just being able to talk freely about a
problem brings relief. In the early stages, your psychologist will help
you clarify what’s troubling you. You’ll then move into a problem-
solving phase, working together to find alternative ways of thinking,
behaving, and managing your feelings.

You might role-play new behaviors during your sessions and do

homework to practice new skills in between. As you go along, you and
your psychologist will assess your progress and determine whether
:
 your original goals need to be reformulated or expanded.

In some cases, your psychologist may suggest involving others. If

you’re having relationship problems, for instance, having a spouse or
partner join you in a session can be helpful. Similarly, an individual
having parenting problems might want to bring his or her child in. And
someone who has trouble interacting with others may benefit from
group psychotherapy.

As you begin to resolve the problem that brought you to

psychotherapy, you’ll also be learning new skills that will help you see
yourself and the world differently. You’ll learn how to distinguish
between situations you can change and those you can’t and how to
focus on improving the things within your control.

You’ll also learn resilience, which will help you better cope with future
challenges. A 2006 study of treatment for depression and anxiety
(http://www.ncbi.nlm.nih.gov/pubmed/16318597) , for example, found that
the cognitive and behavioral approaches used in psychotherapy have
an enduring effect that reduces the risk of symptoms returning even
after treatment ends. Another study found a similar result when
evaluating the long-term effects of psychodynamic psychotherapy
(/news/press/releases/2010/01/psychodynamic-therapy) .

Soon you’ll have a new perspective and new ways of thinking and
behaving.

How can I make the most of psychotherapy?

Psychotherapy is different from medical or dental treatments, where
patients typically sit passively while professionals work on them and
tell them their diagnosis and treatment plans. Psychotherapy isn’t
about a psychologist telling you what to do. It’s an active collaboration
between you and the psychologist.

In fact, hundreds of studies have found

that a very important part of what
makes psychotherapy work
(/news/press/releases/2009/12/wampold)
is the collaborative relationship between
psychologist and patient, also known as a therapeutic alliance. The
therapeutic alliance is what happens when the psychologist and
patient work together to achieve the patient’s goals.

So be an active, engaged participant in psychotherapy. Help set goals

for treatment. Work with your psychologist to come up with a
timeline. Ask questions about your treatment plan. If you don’t think a
session went well, share that feedback and have a dialogue so that the
psychologist can respond and tailor your treatment more effectively.
Ask your psychologist for suggestions about books or websites with
useful information about your problems.
:
 And because behavior change is difficult, practice is also key. It’s easy
to fall back into old patterns of thought and behavior, so stay mindful
between sessions. Notice how you’re reacting to things and take what
you learn in sessions with your psychologist and apply it to real-life
situations. When you bring what you’ve learned between sessions
back to your psychologist, that information can inform what happens
in his or her office to further help you.

Through regular practice, you’ll consolidate the gains you’ve made, get
through psychotherapy quicker, and maintain your progress after
you’re done.

Should I worry about confidentiality?

Psychologists consider maintaining your privacy extremely important.
It is a part of their professional code of ethics. More importantly, it is a
condition of their professional license. Psychologists who violate
patient confidentiality risk losing their ability to practice psychology in
the future.

To make your psychotherapy as effective as possible, you need to be

open and honest about your most private thoughts and behaviors.
That can be nerve-wracking, but you don’t have to worry about your
psychologist sharing your secrets with anyone except in the most
extreme situations.

If you reveal that you plan to hurt yourself or others, for example, your
psychologist is duty-bound to report that to authorities for your own
protection and the safety of others. Psychologists must also report
abuse, exploitation, or neglect of children, the elderly, or people with
disabilities. Your psychologist may also have to provide some
information in court cases.

Of course, you can always give your psychologist written permission

to share all or part of your discussions with your physician, teachers,
or anyone else if you desire.

Psychologists take confidentiality so seriously that they may not even

acknowledge that they know you if they bump into you at the
supermarket or anywhere else. And it’s OK for you to not say hello
either. Your psychologist won’t feel bad; he or she will understand that
you’re protecting your privacy.

Understanding medication
In our quick-fix culture, people often hope a pill will offer fast relief
from such problems as depression or anxiety. And primary care
physicians or nurse practitioners—most people’s first contact when
they have a psychological problem—are typically trained to prescribe
medication. They don’t have the extensive training or the time to
provide psychotherapy.
:
 provide psychotherapy.

Is medication effective?
There are some psychological conditions, such as severe depression,
bipolar disorder, or schizophrenia, where medication is clearly
warranted. But many other cases are less clear-cut.

Evidence suggests that in many cases, medication doesn’t always

work. In a 2010 study in the Journal of the American Medical
Association, for instance, researchers reviewed previous research on
the effectiveness of antidepressants
(http://www.ncbi.nlm.nih.gov/pubmed/20051569) . They found that
antidepressants did help people with severe cases of depression. For
mild to moderate depression, however, the medication wasn’t any
more effective than a placebo.

What’s more, medications don’t help you develop the skills you need
to deal with life’s problems. Once you stop taking medication, your
problems often remain or come back. In contrast, psychotherapy will
teach you new problem-solving strategies that will also help you cope
with future problems.

Do I need medication?
If you can function relatively well—meaning you can function well at
work or school and have healthy relationships with family and friends
—the answer is probably no. Psychotherapy alone can be very
effective. Or you might just need a more balanced lifestyle—one that
combines work, exercise, and social interactions.

Medication can be useful in some situations, however. Sometimes,

people need medication to get to a point where they’re able to engage
in psychotherapy. Medication can also help those with serious mental
health disorders. For some conditions, combining psychotherapy and
medication works best.

How can I get medication if I need it?

If you need medication, your psychologist will work with your primary
care provider or a psychiatrist to ensure a coordinated approach to
treatment that is in your best interest.

Five states, Idaho, Illinois, Iowa, Louisiana, and New Mexico, have laws
allowing licensed psychologists with advanced training to prescribe
certain medications to treat emotional and mental health problems. In
those states, the psychologists must have completed a specialized
training program (often earning a master’s degree in
psychopharmacology), passed an examination for prescribing, and be
additionally licensed as prescribing psychologists.

Assessing psychotherapy’s
:
 Assessing psychotherapy’s
effectiveness
Some people wonder why they can’t just talk about their problems
with family members or friends. Psychologists offer more than
someplace to vent. Psychologists have years of training and
experience that help people improve their lives. And there is
significant evidence showing that psychotherapy is a very effective
treatment.

How does psychotherapy work?

Successful treatment is the result of three factors working together:

Evidence-based treatment that is appropriate for your problem

The psychologist’s clinical expertise

Your characteristics, values, culture, and preferences

When people begin psychotherapy, they often feel that their distress
is never going to end. Psychotherapy helps people understand that
they can do something to improve their situation. That leads to
changes that enhance healthy behavior, whether it’s improving
relationships, expressing emotions better, doing better at work or
school, or thinking more positively.

While some issues and problems respond best to a particular style of

therapy, what remains critical and important is the therapeutic
alliance and relationship with your psychologist.

What if psychotherapy doesn’t seem to be

working?
When you began psychotherapy, your psychologist probably worked
with you to develop goals and a rough timeline for treatment. As you
go along, you should be asking yourself whether the psychologist
seems to understand you, whether the treatment plan makes sense,
and whether you feel like you’re making progress.

Some people begin to feel better in

about six to 12 sessions. If you don’t start
seeing signs of progress, discuss it with
your psychologist. Your psychologist
may initiate a conversation about what
to do. If he or she doesn’t, bring it up yourself. You could ask your
psychologist about additional or alternative treatment methods, for
example. Sometimes speaking up to your psychologist can be very
empowering, especially since your psychologist will be understanding
and nonjudgmental instead of offended.

Keep in mind that as psychotherapy progresses, you may feel

overwhelmed. You may feel more angry, sad, or confused than you did
:
 overwhelmed. You may feel more angry, sad, or confused than you did
at the beginning of the process. That doesn’t mean psychotherapy
isn’t working. Instead, it can be a sign that your psychologist is
pushing you to confront difficult truths or do the hard work of making
changes. In such cases, these strong emotions are a sign of growth
rather than evidence of a standstill. Remember, sometimes things may
feel worse before they get better.

In some cases, of course, the relationship between a patient and the

psychologist isn’t as good as it should be. The psychologist should be
willing to address those kinds of issues, too. If you’re worried about
your psychologist’s diagnosis of your problems, it might be helpful to
get a second opinion from another psychologist, as long as you let
your original psychologist know you’re doing so.

If the situation doesn’t improve, you and your psychologist may

decide it’s time for you to start working with a new psychologist. Don’t
take it personally. It’s not you; it’s just a bad fit. And because the
therapeutic alliance is so crucial to the effectiveness of
psychotherapy, you need a good fit.

If you do decide to move on, don’t just stop coming to your first
psychologist. Instead, tell him or her that you’re leaving and why
you’re doing so. A good psychologist will refer you to someone else,
wish you lucky, and urge you not to give up on psychotherapy just
because your first attempt didn’t go well. Tell your next psychologist
what didn’t work to help ensure a better fit.

Knowing when you’re done

You might think that undergoing psychotherapy means committing to
years of weekly treatment. Not so.

How long should psychotherapy take?

How long psychotherapy takes depends on several factors: the type of
problem or disorder, the patient’s characteristics and history, the
patient’s goals, what’s going on in the patient’s life outside
psychotherapy, and how fast the patient is able to make progress.

Some people feel relief after only a single session of psychotherapy.

Meeting with a psychologist can give a new perspective, help them
see situations differently, and offer relief from pain. Most people find
some benefit after a few sessions, especially if they’re working on a
single, well-defined problem and didn’t wait too long before seeking
help.

If you’ve been suffering from extreme

anxiety, for example, you might feel
better simply because you’re taking
action—a sign of hope that things will
change. Your psychologist might also
:
 offer a fresh perspective early in your treatment that gives you a new
understanding of your problem. And even if your problem doesn’t go
away after a few sessions, you may feel confident that you’re already
making progress and learning new coping skills that will serve you
well in the future.

Other people and situations take longer—maybe a year or two—to

benefit from psychotherapy. They may have experienced serious
traumas, have multiple problems, or just be unclear about what’s
making them unhappy. It’s important to stick with psychotherapy long
enough to give it a chance to work.

People with serious mental illness or other significant life changes

may need ongoing psychotherapy. Regular sessions can provide the
support they need to maintain their day-to-day functioning.

Others continue psychotherapy even after they solve the problems

that brought them there initially. That’s because they continue to

experience new insights, improved well-being, and better functioning.

How do I know when I’m ready to stop?

Psychotherapy isn’t a lifetime commitment.

In one classic study, half of psychotherapy patients improved

(http://www.ncbi.nlm.nih.gov/pubmed/3516036) after eight sessions. And
75% improved after six months.

You and your psychologist will decide together when you are ready to
end psychotherapy. One day, you’ll realize you’re no longer going to
bed and waking up worrying about the problem that brought you to
psychotherapy. Or you will get positive feedback from others. For a
child who was having trouble in school, a teacher might report that
the child is no longer disruptive and is making progress both
academically and socially. Together you and your psychologist will
assess whether you’ve achieved the goals you established at the
beginning of the process.

What happens after psychotherapy ends?

You probably visit your physician for periodic check-ups. You can do
the same with your psychologist.

You might want to meet with your

psychologist again a couple of weeks or
a month after psychotherapy ends just
to report how you’re doing. If all is well,
you can wrap things up at that follow-
up session.

And don’t think of psychotherapy as having a beginning, middle and

end. You can solve one problem, then face a new situation in your life
:
 end. You can solve one problem, then face a new situation in your life
and feel the skills you learned during your last course of treatment
need a little tweaking. Just contact your psychologist again. After all,
he or she already knows your story.

Of course, you don’t have to wait for a crisis to see your psychologist
again. You might just need a “booster” session to reinforce what you
learned last time. Think of it as a mental health tune-up.

The American Psychological Association gratefully acknowledges the

assistance of June Ching, PhD; Angela Londoño-McConnell, PhD; Elaine
Ducharme, PhD; Terry Gock, PhD; Bethe Lonning, PsyD; Nancy Molitor, PhD;
Dianne Polowczyk, PhD; and Michael Ritz, PhD, in developing this material.

Related Reading
Protecting your privacy:
Understanding confidentiality

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