Therapy and Mental Health Treatment: Types of Therapy and How to Choose

Therapy, also called psychotherapy or counseling, is a structured, confidential process in which a trained mental health professional helps a person, couple, family or group understand and change patterns of thinking, feeling and behaving. The main types of therapy include cognitive behavioral therapy (CBT), psychodynamic therapy, humanistic therapy, dialectical behavior therapy (DBT), interpersonal therapy (IPT), acceptance and commitment therapy (ACT), EMDR and family or couples therapy.

Choosing well comes down to three things: a type of therapy with reasonable evidence for your concern, a qualified professional you feel able to work with, and practical arrangements, such as cost, format and schedule, that let you attend consistently. This page walks through each of these. For a fuller catalogue of approaches, see our types of therapy hub.

Understanding Therapy

All forms of psychotherapy share some core features: a trained professional, an agreed purpose, regular meetings, and methods grounded in a psychological theory of how problems develop and change. Beyond that, approaches differ in what they focus on (thoughts, emotions, relationships, past experiences, behaviour or the body), how structured they are and how long they last.

Therapy isn't only for people in crisis or with a diagnosed condition. People also use it to navigate grief, relationship difficulties, stress, life transitions and questions about identity or direction.

Does therapy work?

Research says yes for many people, though not for everyone. In a landmark 1977 meta-analysis of 375 studies, Mary Lee Smith and Gene Glass found that the average person receiving therapy was better off than about 75% of comparable untreated people. Thousands of later trials have confirmed that established psychotherapies help with depression, anxiety disorders, PTSD, eating disorders and many other problems.

Two further findings shape how researchers think about therapy today:

• Common factors matter. Bruce Wampold and colleagues have argued, from meta-analytic evidence, that elements shared across therapies, such as the alliance with the therapist, empathy and a credible rationale, account for much of the benefit.
• Specific methods matter too, for some problems. For example, exposure-based treatments for phobias, panic disorder and OCD and trauma-focused therapies for PTSD have stronger evidence than general supportive counseling for those conditions.

Major Types of Therapy

The table summarises the most widely used approaches. Each has its own page with more detail.

Cognitive Behavioral Therapy (CBT)

CBT, developed from the work of Aaron Beck and behavior therapists in the 1960s and 1970s, helps people notice unhelpful thought patterns and behaviours and test alternatives. Sessions are structured, goal-focused and usually include practice between sessions. It is the most extensively researched psychotherapy. Specialised forms include exposure and response prevention for OCD (ERP), trauma-focused CBT and behavioral activation for depression.

Psychodynamic Therapy

Psychodynamic therapy grew out of psychoanalysis. It explores how unconscious feelings, early experiences and recurring relationship patterns shape current difficulties, including how those patterns show up with the therapist. Modern short-term forms are more structured than classical analysis. Reviews such as Shedler (2010) report effect sizes comparable to other established therapies, though the trial base is smaller than for CBT.

Dialectical Behavior Therapy (DBT)

Developed by Marsha Linehan, DBT combines CBT with mindfulness and an emphasis on balancing acceptance with change. Standard DBT includes individual therapy, a weekly skills group, phone coaching and a therapist consultation team. Randomised trials support it for reducing self-harm and suicidal behaviour in people with borderline personality disorder.

Acceptance and Commitment Therapy (ACT)

ACT, developed by Steven Hayes and colleagues, encourages people to make room for difficult thoughts and feelings rather than fight them, and to act in line with their values. Evidence is growing, with good support for chronic pain and promising results for anxiety and depression.

EMDR

Eye movement desensitization and reprocessing, introduced by Francine Shapiro in 1989, asks clients to recall traumatic memories while following bilateral stimulation such as side-to-side eye movements. Guidelines from bodies including the World Health Organization and NICE recommend EMDR for PTSD. Whether the eye movements themselves add much beyond the exposure element remains debated.

Interpersonal Therapy (IPT)

IPT, developed by Gerald Klerman and Myrna Weissman, is a time-limited therapy that links mood to current relationships and focuses on one or two problem areas, such as grief, disputes, role transitions or isolation. It is well established for depression.

Humanistic and Person-Centered Therapy

Rooted in humanistic psychology and the work of Carl Rogers, person-centered therapy emphasises empathy, unconditional positive regard and genuineness, trusting clients to find their own direction. Related approaches include gestalt and existential therapy. Evidence supports benefit for general distress and mild to moderate depression.

Family and Couples Therapy

Family systems therapy treats problems as part of patterns within a family rather than located in one person. Couples therapy approaches include emotionally focused therapy and the Gottman method. Family-based treatment has some of the best evidence for anorexia nervosa in adolescents.

Specialized Therapy Formats and Approaches

Group therapy

Group therapy brings several clients together with one or two therapists. Beyond lower cost, groups offer peer support, the realisation that others share similar struggles and a place to practise social skills. Group CBT, DBT skills groups and grief groups are common examples.

Online therapy

Therapy by video, phone or messaging has grown rapidly. Research suggests video therapy performs comparably to in-person sessions for many common problems, though it is less suitable for crises or situations needing close monitoring. See online therapy.

Expressive therapies

Art therapy, music therapy, dance and movement therapy and drama therapy use creative activity as a route to expression, especially when words are hard to find. They are delivered by credentialed practitioners; the evidence base is smaller and more mixed than for talking therapies.

Somatic and body-oriented therapies

Somatic approaches such as somatic experiencing and sensorimotor psychotherapy attend to bodily sensations and arousal, often in trauma work. They are popular, but controlled research is still limited, so claims about their effectiveness should be read cautiously.

Play therapy for children

Play therapy uses play as the main medium of communication for younger children. Treatments for children and teens often involve parents, and some, such as parent management training for disruptive behaviour, work mainly through parents.

Types of Mental Health Professionals

Many professions provide therapy. Titles and scope vary by country and US state; this table describes common US patterns. Our guide to mental health professionals goes deeper.

How to Choose a Therapist

Choosing a therapist is partly practical and partly personal. A step-by-step approach helps:

1. Clarify what you want help with. A specific problem (panic attacks, intrusive thoughts, a relationship crisis) points toward therapists with relevant training. A broader wish to understand yourself leaves more room for preference.
2. Check practical limits. Budget or insurance, in-person versus online, schedule and any preferences about the therapist's gender, language or cultural background.
3. Search in several places. Your insurer's directory, your primary care doctor, professional association directories, university or community clinics and reputable online directories. Our guides on finding a therapist and choosing the right therapist cover the search in detail.
4. Verify credentials. State licensing boards let you check that a licence is current and whether there have been disciplinary actions.
5. Use a consultation call. Ask the questions below and notice how you feel talking to the therapist.
6. Review after a few sessions. Ask yourself whether you feel understood, whether there's a clear plan and whether you can be honest.

Questions to ask a potential therapist

• What experience and training do you have with concerns like mine?
• What approach would you use, and why?
• How will we measure whether therapy is helping?
• What is a typical length of treatment for this kind of problem?
• What are your fees, and do you accept my insurance or offer a sliding scale?
• What is your cancellation policy, and how do I reach you between sessions?

Red flags

• Promises of quick or guaranteed results.
• No verifiable licence, or reluctance to discuss credentials.
• Boundary violations, such as romantic or business relationships with clients.
• Dismissing your concerns, or pressuring you to adopt their beliefs.
• Talking mostly about their own life.
• Careless handling of confidentiality.

What to Expect in Therapy

The first session

The first appointment is usually an intake: paperwork, a discussion of your concerns and history, a routine safety check and an initial plan. Our guide to preparing for your first therapy session walks through it step by step.

Ongoing sessions

Individual sessions typically last 45 to 50 minutes, often weekly at first. Depending on the approach, sessions might involve reviewing the week, working on a specific problem, practising a skill, exploring feelings or patterns, and agreeing on something to try before the next meeting. Good therapists check progress regularly, sometimes with brief questionnaires.

The therapeutic relationship

The therapeutic alliance, meaning agreement on goals and tasks plus a bond of trust, is one of the most consistently studied predictors of outcome. A 2018 meta-analysis of more than 200 studies found a reliable, moderate link between alliance strength and improvement across therapy types. It is not the only thing that matters, but it is a good reason to take fit seriously.

Common challenges

• Early discomfort. Talking about painful topics can feel worse before it feels better.
• Plateaus. Progress is uneven; periods of little apparent change are common.
• Ambivalence about change. Wanting change and fearing it at the same time is normal and can be discussed.
• Therapy-interfering behaviors. In DBT and schema therapy, behaviours such as missing sessions, not completing agreed practice or, on the therapist's side, being disengaged are named openly and worked on together.

Making the Most of Therapy

• Be as honest as you can, including about things that feel embarrassing or about how therapy itself is going.
• Take an active role. Bring topics, ask questions and practise skills between sessions.
• Give feedback. Research on routine outcome monitoring suggests that therapists who regularly ask for client feedback can catch problems earlier.
• Attend consistently. Regular sessions build momentum.
• Keep notes of insights and techniques so you can use them later.

Signs therapy is helping

Signs include reduced distress, better day-to-day functioning, more effective coping, clearer understanding of your patterns and progress toward the goals you set. Change is often gradual and noticed first by others.

When to consider changing therapists

Consider raising concerns, and if needed changing, if you feel judged or misunderstood after several sessions, there is no clear plan or progress after a reasonable period (often a few months), the therapist lacks expertise in your main concern, or there are any boundary violations.

Cost and Insurance Considerations

In the US, self-pay sessions commonly cost between about $100 and $250, and insurance can reduce that to a copay. Lower-cost routes include sliding-scale fees, community mental health centers, university training clinics, employee assistance programs and group therapy. Our therapy cost guide, sliding scale therapy and therapy without insurance pages explain the options, including how to ask about benefits and claim out-of-network reimbursement.

Special Considerations

Children and adolescents

Therapy for young people adapts to developmental stage: play-based work for younger children, more talk-based work for teens and frequent involvement of parents or carers. Confidentiality rules for minors differ, and therapists should explain what will be shared with parents.

Culturally responsive therapy

Culture shapes how people experience and express distress and what help feels acceptable. Culturally responsive therapists ask about these factors, respect clients' values and recognise the effects of discrimination and social circumstances. Working in your preferred language, or with a qualified interpreter, can make a significant difference.

LGBTQ+ affirming therapy

Affirming therapists treat sexual orientation and gender identity as normal variations, not problems to fix, and understand minority stress, the added strain that comes from stigma and discrimination. Major professional bodies oppose so-called conversion therapy as ineffective and harmful.

Trauma-informed care

Trauma-informed services recognise how common trauma is and prioritise safety, choice, collaboration and avoiding re-traumatisation. This is a way of delivering care. It is different from trauma-focused treatments such as CPT, prolonged exposure or EMDR, which directly target trauma memories.

When to Seek Therapy

People often consider therapy when difficulties persist for weeks, keep recurring or interfere with work, study, relationships or self-care. Common reasons include ongoing low mood or worry, panic, intrusive thoughts, the aftermath of trauma or loss, relationship patterns that keep repeating, concerns about alcohol or drug use, problems with eating or body image, chronic stress or burnout and sleep problems that won't settle.

You don't need to be in crisis. Therapy can also support personal growth, decision-making and resilience. If you are unsure whether what you're experiencing warrants help, a primary care doctor or a licensed therapist can talk it through with you. Screening questionnaires can be a starting point but are not a diagnosis; see mental health screening tools.

Medication and Therapy

Medication is one treatment option a doctor, psychiatrist or psychiatric nurse practitioner may discuss, particularly for more severe or persistent conditions and for conditions such as bipolar disorder or schizophrenia where medical treatment is usually central. For some conditions, such as moderate to severe depression, research suggests that combining psychotherapy with medication can be more effective than either alone. For many mild to moderate problems, therapy alone is a well-supported first option.

Decisions about medication belong in a conversation with a prescriber who knows your history. When more than one professional is involved, coordination (with your written permission) helps keep treatment consistent.

Ending Therapy

Therapy usually ends when goals are largely met, when progress levels off, or when circumstances change. A planned ending typically involves reviewing what has changed, identifying what helped, planning how to handle setbacks and agreeing how to return if needed. Some people taper to fortnightly or monthly sessions, or book occasional "booster" sessions. Ending is easier to do well when it is discussed openly rather than by simply stopping.

Therapy Myths and Misconceptions

For more, see mental health myths debunked.

Resources and Support

Professional associations such as the American Psychological Association, the National Association of Social Workers, the American Counseling Association and the American Association for Marriage and Family Therapy publish public information and directories. Government sources such as the National Institute of Mental Health and SAMHSA (whose FindTreatment.gov locator lists services) offer reliable background. Nonprofits such as NAMI run free peer support groups.

On this site, start with the types of therapy hub, our overview of free mental health resources and the getting help hub.