How Therapy Works

Psychotherapy works by providing an opportunity for change when one is anxious, depressed, or feeling generally stuck. Understanding how therapy works and what elements of therapy to look for can be challenging, especially to those who are considering counseling for the first time. But you have taken an important first step.

What Makes Psychotherapy Effective

Effective psychotherapy, regardless of the mode of treatment, the therapist’s professional discipline, or the specific therapeutic approach being used, involves several essential elements.

Critical to success is a supportive relationship with a skilled clinician – one who truly listens and is able to give constructive feedback, has the knowledge and tools to help you understand how the past may be impacting your life in the present, and can help you grow and make the changes necessary for a more satisfying life. (See articles in the posts section that address the many kinds of change facilitated by therapy.)

Therapists also differ in personal characteristics that influence the ‘fit’ and how well psychotherapy works for you. These characteristics include: experience and training, warmth and directness, activity level and energy in the sessions, and degree of personal self-disclosure.

Key Elements in How Therapy Works

To understand more about how psychotherapy works, it is also important to understand the differences between the various modalities of care, the professional disciplines offering mental health services, and the different schools of therapy.

Treatment Modalities

• Individual Therapy: One-on-one counseling, focusing on personal challenges, thoughts, and feelings.
• Couples Therapy: Partners working together to improve communication, resolve conflict, and strengthen their relationship.
• Family Therapy: Multiple family members coming together to address patterns that affect the whole family system, such as parenting challenges or inter-generational conflict.
• Group Therapy: Several individuals working in a group format to learn from one another while guided by a skilled facilitator.

Professional Disciplines in Mental Health

• Psychiatrists: Medical doctors (MD/DO) who can prescribe medication, and some also provide psychotherapy.
• Psychologists: Hold doctoral degrees (PhD or PsyD), trained extensively in assessment, diagnosis, research, and psychotherapy.
• Social Workers (LICSW/LCSW): Clinically trained to provide counseling and psychotherapy, often with a strong emphasis on environment, relationships, and resources.
• Licensed Mental Health Counselors (LMHC, LPC): Master’s-level clinicians trained to provide psychotherapy, counseling, and practical coping skills.
• Coaches: Typically not licensed clinicians; focus on goal-setting, motivation, and behavior change in specific areas like career or wellness, but not mental illness.

Schools of Therapy

• Psychodynamic Therapy: Explores how unconscious patterns and early life experiences shape current behavior.
• Interpersonal Therapy (IPT): Focuses on improving communication and relationships as a pathway to reducing depression and anxiety.
• Relational Therapy: Emphasizes the therapist–client relationship as a microcosm of real-life dynamics, using it as a space for healing.
• Internal Family Systems (IFS): Works with “parts” of the self (such as inner critic, protector, wounded child) to restore balance and self-leadership.
• Behavioral Therapy
  • Cognitive Behavioral Therapy (CBT): Teaches skills to identify and change unhelpful thought patterns and behaviors.
  • Acceptance and Commitment Therapy (ACT): Encourages acceptance of thoughts/feelings while taking actions aligned with values.
  • Dialectical Behavior Therapy (DBT): Blends CBT with mindfulness; effective for emotion regulation and relationship skills.
  • Eye Movement Desensitization and Reprocessing (EMDR): Uses guided eye movements or tapping to help process trauma and reduce distress.

• Research Insights: What Really Matters
• Research suggests the best therapists, using different formal approaches, often look more alike in how they operate than do highly skilled versus less skilled clinicians within the same approach. Most effective clinicians also incorporate more than one style, tailoring their counseling approach to the client’s needs and goals.

Common Questions About Therapy

Is it useful to have more than one kind of therapy at the same time?

Yes. It might be useful to have two therapists concomitantly — for example, an individual psychologist for yourself while also working with your partner on relationship issues or parenting a child with failure-to-launch issues. Many people are also simultaneously in individual counseling and group therapy, which can increase the effectiveness of both.

It can also be helpful to have two individual therapists — for example, a psychologist offering interpersonal psychotherapy over a long time period, and a counselor providing a focused treatment for a specific problem such as alcohol moderation training or helping a family to intervene when a loved one has an alcohol problem.

How do I decide which modality (or combination of modalities) would be best for me?

Often people find that a brief consultation (one or two sessions with a therapy consultant) is beneficial in making this decision.

How is counseling different from psychotherapy?

These terms are often used interchangeably, and many skilled clinicians do both. To the extent that there may be a distinction, counseling at times refers to a more focused approach to a discrete issue (e.g., alcohol counseling or medical illness counseling), whereas psychotherapy often involves in-depth exploration of broader issues such as repeated interpersonal strains, loneliness, or a sense of meaninglessness.

How do I pay for therapy?

• Insurance Coverage: Most insurers cover therapy services to varying degrees, depending on the provider’s discipline and your plan. Contact your insurer for details on co-pays, deductibles, and number of sessions covered.
• In-Network vs. Out-of-Network: An in-network provider has a contract with your insurer, usually lowering out-of-pocket costs. An out-of-ne twork therapist does not, but if you have a PPO plan, you may be reimbursed for part of the fee after paying the therapist and submitting claims.
• Private Pay: Many clients choose to pay out of pocket, appreciating the privacy and flexibility it allows.
• Health Savings Accounts (HSA/FSA): Therapy often qualifies as a reimbursable medical expense.