Therapy: the basics

Some talk therapies teach practical skills for the here and now, like CBT, exposure therapy, ACT and DBT. Others help you understand how your past and relationships shape you, like psychodynamic, person-centred and interpersonal therapy.

Trauma-focused therapies help painful memories lose their grip. The VA says several of them are highly recommended for PTSD, and most last about 3 months.

Creative arts therapies use play, art, music, drama or movement inside a therapy relationship. No talent is needed. Mind–body approaches include mindfulness courses like MBCT.

Sometimes the best place to heal is together. Family and couples therapy work on patterns between people. Group therapy and peer support help you feel less alone.

Levels of care describe how much help someone gets, how often, and where. Most people use outpatient care, like weekly sessions. Some need more for a while, and that’s normal.

In counselling, you talk with a trained therapist about your thoughts, feelings and life experiences. The therapist listens and helps you find your own solutions.

Counselling is often shorter and focused on a specific issue, like a breakup, stress or a loss, while psychotherapy is often longer-term. In everyday life, people use the words interchangeably.

Supportive counselling, which gives a space to explore hard things and receive emotional support, is one of the building blocks NIMH describes in therapy.

For many people, faith is central to how they cope and find meaning. Faith-integrated therapy weaves your spiritual beliefs into evidence-based care. Pastoral counsellors are clergy or faith leaders who also have clinical training.

Different kinds of faith-based help

• Licensed therapists who integrate faith with their training
• Pastoral counsellors with both faith and clinical training
• Chaplains in hospitals, the military, prisons and universities
• Spiritual guidance from a faith leader (support, not therapy)

In the U.S., the Association for Clinical Pastoral Education trains spiritual care professionals and certifies spiritually integrated psychotherapists.

Questions to ask

• “Are you licensed as a mental health professional?”
• “How do you bring faith into sessions? Will you follow my lead?”
• “Do you have experience with my faith tradition?”

Telehealth lets you see a therapist by video or phone. There are also web programmes and apps, some with a therapist and some without.

Evidence: many trials run by the U.S. Department of Veterans Affairs found PTSD therapy by video works as well as in person in most cases.

Good for…

• Rural areas or places with few therapists
• People with busy schedules, disabilities or no transport
• Finding a therapist who shares your language, culture or faith

Tips for safe online therapy

• Check the therapist is licensed in the state where you live
• Find a private space, or use headphones
• Ask what happens if the call drops or you’re in crisis
• Be careful with apps: check who runs them and what they do with your data

In guided self-help, you work through a workbook or online course with support from a therapist. It is based on CBT and is often the first step in NHS talking therapies for anxiety and low mood. If it doesn’t help enough, a different therapy can be offered.

Common pairings in research

• Worry, panic and phobias: CBT, exposure therapy
• OCD: ERP
• Low mood: CBT, behavioural activation, IPT; MBCT to help prevent it coming back
• Trauma: CPT, prolonged exposure, EMDR; TF-CBT for kids
• Very intense emotions and self-harm: DBT, MBT
• Relationship struggles: couples or family therapy, IPT
• Shame and harsh self-criticism: CFT
• Mixed feelings about changing a habit: motivational interviewing

NIMH says rapport and trust are essential. You’ll be sharing personal things, so you should feel comfortable with your therapist.

Signs of a good fit

• You feel listened to and respected
• They explain their approach in words you understand
• You agree on goals together
• They welcome your feedback, even “this isn’t working”
• They respect your culture, faith and identity

Red flags

• They dismiss your feelings or judge you
• They push you to share more than you’re ready to
• They break boundaries (like wanting a friendship or romance)
• They promise instant cures

Therapy can be offered by psychologists, psychiatrists, clinical social workers, licensed counselors, marriage and family therapists and psychiatric nurses. Their training and specialties differ, so check credentials and experience.

Specialised therapists, like art, music, drama and dance/movement therapists, and pastoral counsellors, have their own credentials and training.

Confidentiality is standard in therapy. But therapists must act if you have plans to harm yourself or someone else, or if they suspect abuse or neglect of a child, older adult or person with a disability. You can also give written permission for them to share information with others.

Facing hard feelings or memories can be uncomfortable at first. In exposure, CPT and PE, discomfort is expected and usually eases as you continue. If you feel much worse, tell your therapist straight away.

If you’ve been in therapy for a reasonable time without improvement, NIMH suggests talking with your therapist about trying another approach or professional.

Many therapies, like CBT, ACT, DBT, CPT and PE, include practice between sessions: worksheets, trying a skill, or small brave steps. Therapy tends to work best when you’re open, committed and do the practice.

Some therapies, like EMDR and person-centred counselling, have little or no homework.

Rough guide

• Solution-focused and MI: often a handful of sessions
• CBT: many people attend 8–12 visits
• CPT and PE: about 3 months
• Family therapy: about 12 sessions for short-term issues
• DBT: usually 6 months to a year
• MBT: around 18 months
• Psychodynamic: months to years

You’re often “done” when the original problem has eased and you have skills for the future. Many people come back at different points in life, and that’s healthy.

People go to therapy for stress, grief, relationship problems, work worries, big life changes or simply to understand themselves. It also helps people supporting a loved one who is struggling.

Therapists are trained in specific methods. Large studies show evidence-based therapies reduce symptoms of depression, anxiety and other conditions. About 75% of people in psychotherapy get some benefit.

Many people attend 8–12 CBT visits. CPT is usually 12 sessions. Some therapies are longer, and that’s fine too. You and your therapist decide together.

That image comes from classical psychoanalysis, which is now rare. Many therapies, like CBT, ACT and solution-focused therapy, focus mostly on the present and future. You choose what to talk about.

You can ask for a therapist who respects your beliefs, or a faith-integrated or pastoral counsellor with clinical training.

NIMH says if you haven’t improved after a reasonable time, talk about trying a different professional or approach. Trust and rapport are essential.

Everyone needs support sometimes. Reaching out to a therapist, a peer or your community is a brave, wise step. Whatever kind of care you and your clinical provider choose is valid.

Effective therapy for children often includes parent involvement, skills practised at home or school, and tracking progress. Family counselling can help everyone understand how a child’s struggles affect the family.

Approaches often used

• Play therapy for younger children
• CBT adapted for kids
• TF-CBT after trauma (ages 3–18)
• Parent training and support groups
• Family therapy

Teens often do best when they feel respected and have a say. Therapies like CBT, DBT (with adapted family involvement), ACT and group therapy are common. School counsellors can be a helpful first step.

Tips for teens

• You can ask your therapist what stays private and what parents will hear
• You’re allowed to say if a therapist isn’t right for you
• Online therapy can feel easier for some teens

Adults can use any of the therapies in this guide. Evening or video appointments, group therapy and Employee Assistance Programs (EAPs) can make therapy easier to fit in.

Therapy works at any age. Psychodynamic therapy can be used at any age, and MBCT’s benefits did not depend on age in research. Music therapy is used with people living with dementia and in care homes.

Things that can help

• Phone or video sessions if getting out is hard
• Bringing a trusted person to the first visit
• Asking for larger print or slower pace
• Group therapy for connection and company

Couples therapy helps with communication, trust, parenting, money and intimacy. Approaches include the Gottman Method and Emotionally Focused Therapy.

Family therapy can help with conflict, grief, divorce, big changes, a family member’s illness, or supporting a neurodivergent family member.

Helpful things to say

• “I’m proud of you for looking into this.”
• “Would it help if I sat with you while you make the call?”
• “You don’t have to tell me what you talk about. I’m just here.”
• “It’s OK if the first therapist isn’t the right fit.”
• “How are you feeling about it?”

Borrow the spirit of motivational interviewing: ask open questions, listen and reflect back, rather than lecturing. People are more likely to act on reasons that come from them.

Try to avoid

• “So what did you talk about?” (let them share if and when they want)
• “Are you fixed yet?”
• “You just need to think positive.”
• “Therapy is for people with real problems.”
• “I bet they blamed me.”

Ways to help

• Help search directories or call insurance together
• Offer a ride, or help set up a quiet space for video sessions
• Help with childcare or chores on therapy days
• Help them write down questions to ask (try the worksheets)
• Encourage, but don’t force, practice between sessions
• Join family or couples sessions if invited

For children, parent involvement is a key part of effective therapy, and therapists can coach parents on working with schools.

Supporting someone can be tiring and worrying. Therapy can help people supporting a family member with a mental health condition, too.

Look after yourself

• Keep your own routines, rest and joys
• Talk to someone you trust, or a peer support group for families
• Set kind boundaries: you can’t be someone’s only support
• Consider your own therapy, or family therapy together

• A school or college counsellor
• FindTreatment.gov, SAMHSA’s locator for mental health services
• Your Employee Assistance Program (EAP)
• Your insurance company’s list of therapists
• Your primary care provider
• University training clinics and county health departments

If your therapy isn’t helping, tell your therapist; there are many other approaches to try.

If weekly sessions aren’t enough, ask about more intensive options like day programs. The Levels of care & kinds of help guide explains them, from self-help to hospital and crisis services.

In the UK, you can often refer yourself to NHS talking therapies for anxiety and depression. Elsewhere, Find A Helpline lists free, confidential helplines in many countries.