Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Some types of psychotherapy are considered evidence-based for treating diagnosed mental disorders; other types have been criticized as pseudoscience. For example, Thought Field Therapy has been called a pseudoscience: See also: However, at least to some extent, psychotherapies are supported by neuroscience, tend to have longer-lasting effects than pharmacotherapies, and can improve the effects of pharmacotherapies, including those involving psychedelics.
There are hundreds of psychotherapy techniques, some being minor variations; others are based on very different conceptions of psychology. Most approaches involve one-to-one sessions, between the client and therapist, but some are conducted with groups, including couples and families.
Psychotherapists may be mental health professionals such as psychiatrists, psychologists, mental health nurses, clinical social workers, marriage and family therapists, or licensed professional counselors. Psychotherapists may also come from a variety of other backgrounds, and depending on the jurisdiction may be legally regulated, voluntarily regulated or unregulated (and the term itself may be protected or not).
It has shown general efficacy across a range of conditions, although its efficacy varies by individual and condition. While large-scale reviews support its benefits, debates continue over the best methods for evaluating outcomes, including the use of randomized controlled trials versus individualized approaches. A 2022 umbrella review of 102 meta-analyses found that effect sizes for both psychotherapies and medications were generally small, leading researchers to recommend a paradigm shift in mental health research. Although many forms of therapy differ in technique, they often produce similar outcomes, leading to theories that common factors—such as the therapeutic relationship—are key drivers of efficacy. Challenges include high dropout rates, limited understanding of mechanisms of change, potential adverse effects, and concerns about therapist adherence to treatment fidelity. Critics have raised questions about psychotherapy's scientific basis, cultural assumptions, and power dynamics, while others argue it is underutilized compared to pharmacological treatments.
Definitions The term psychotherapy is derived from Ancient Greek psyche (ψυχή meaning "breath; spirit; soul") and therapeia (θεραπεία "healing; medical treatment"). The Oxford English Dictionary defines it as "The treatment of disorders of the mind or personality by psychological means...", however, in earlier use, it denoted the treatment of disease through hypnotic suggestion."psychotherapy, n.". OED Online. March 2015. Oxford University Press. (accessed 23 May 2015) Psychotherapy is often dubbed as a "talking therapy" or "talk therapy", particularly for a general audience, though not all forms of psychotherapy rely on verbal communication.'Talk Therapy' The American Heritage Dictionary of the English Language, 5th edition Children or adults who do not engage in verbal communication (or not in the usual way) are not excluded from psychotherapy; indeed some types are designed for such cases. Play therapy, developed for children and also used with people with intellectual disability, places less emphasis on verbal ability and lets the client work non-verbally.
The American Psychological Association adopted a resolution on the effectiveness of psychotherapy in 2012 based on a definition developed by American psychologist John C. Norcross: "Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable". The full text of the resolution: Influential editions of a work by psychiatrist Jerome Frank defined psychotherapy as a healing relationship using socially authorized methods in a series of contacts primarily involving words, acts and rituals—which Frank regarded as forms of persuasion and rhetoric.Frank, J. D., & Frank, J. B. (1991, 3rd ed. First published 1961). Persuasion and healing: A comparative study of psychotherapy . Baltimore: Johns Hopkins University Press. Page 2. Historically, psychotherapy has sometimes meant "interpretative" (i.e. Freudian) methods, namely psychoanalysis, in contrast with other methods to treat psychiatric disorders such as behavior modification.
Some definitions of counseling overlap with psychotherapy (particularly in non-directive client-centered approaches), or counseling may refer to guidance for everyday problems in specific areas, typically for shorter durations with a less medical or "professional" focus.History of Counselling & Psychotherapy Greg Mulhauser, CounsellingResource Library, 2014 Somatotherapy refers to the use of physical changes as injuries and illnesses, and sociotherapy to the use of a person's social environment to effect therapeutic change.Theory and Practice of Nursing: An Integrated Approach to Caring Practice Lynn Basford, Oliver Slevin, Nelson Thornes, 2003. Page 533 Psychotherapy may address spirituality as a significant part of someone's mental / psychological life, and some forms are derived from spiritual philosophies, but practices based on treating the spiritual as a separate dimension are not necessarily considered as traditional or 'legitimate' forms of psychotherapy.Psychotherapy in a Traditional Society: Context, Concept and Practice Vijoy K Varma, Nitin Gupta. Jaypee Brothers Publishers. 2008. Page 230
Delivery Psychotherapy may be delivered in person (one on one, or with couples, with families, or, in groups) or via telephone counseling or online counseling (see also ). There have also been developments in computer-assisted therapy, such as virtual reality therapy for behavioral exposure, multimedia programs to teach cognitive techniques, and handheld devices for improved monitoring or putting ideas into practice (see also ).
Most forms of psychotherapy use spoken conversation. Some also use various other forms of communication such as the written word, artwork, drama, narrative story or music. Psychotherapy with children and their parents often involves play, dramatization (i.e. role-play), and drawing, with a co-constructed narrative from these non-verbal and displaced modes of interacting.
Some therapeutic settings use digital tools to help with session documentation. Ambient systems, for example, employ speech recognition that captures clinician–patient dialogue and generates draft notes for later review. These tools, offered by various vendors including Twofold Health, must comply with privacy and security requirements such as those set out in HIPAA.
Adherence Patient adherence to a course of psychotherapy—continuing to attend sessions or complete tasks—is a major issue.
The dropout level—early termination—ranges from around 30% to 60%, depending partly on how it is defined. The range is lower for research settings for various reasons, such as the selection of clients and how they are inducted. Early termination is associated on average with various demographic and clinical characteristics of clients, therapists and treatment interactions.Jennifer L. Strauss, Vito S. Guerra, Christine E. Marx, A. Meade Eggleston Ph.D, Patrick S. Calhoun Ph.D Chapter 9: Improving Patient Treatment Adherence: A Clinician's Guide In: Improving Patient Treatment Adherence: A Clinician's Guide. Edited by Hayden Bosworth. Springer Science & Business Media, 3 July 2010 The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy.
Most psychologists use between-session tasks in their general therapy work, and cognitive behavioral therapies in particular use and see them as an "active ingredient". It is not clear how often clients do not complete them, but it is thought to be a pervasive phenomenon.
From the other side, the adherence of therapists to therapy protocols and techniques—known as "treatment integrity" or "fidelity"—has also been studied, with complex mixed results. In general, however, it is a hallmark of evidence-based psychotherapy to use fidelity monitoring as part of therapy outcome trials and ongoing quality assurance in clinical implementation.
Regulation
Psychotherapists traditionally may be mental health professionals like psychologists and psychiatrists; professionals from other backgrounds (family therapists, clinical social workers, nurses, etc.) who have trained in a specific psychotherapy; or (in some cases) academic or scientifically trained professionals. In addition to the training, many countries require psychotherapist to register with a professional body in order to be permitted to offer services.
Psychiatrists are trained first as physicians, and as such they may prescribe prescription medication; and specialist psychiatric training begins after medical school in psychiatric residencies: however, their specialty is in mental disorders or forms of mental illness. Clinical psychologists have specialist doctoral degrees in psychology with some clinical and research components. Other clinical practitioners, clinical social workers, mental health counselors, pastoral counselors, and nurses with a specialization in mental health, also often conduct psychotherapy. Many of the wide variety of psychotherapy training programs and institutional settings are multi-professional. In most countries, psychotherapy training is completed at a postgraduate level, often at a master's degree (or doctoral) level, over four years, with significant clinical supervision and clinical placements. Mental health professionals that choose to specialize in psychotherapeutic work also require a program of continuing professional education after basic professional training.
A listing of the extensive professional competencies of a European psychotherapist was developed by the European Association of Psychotherapy (EAP) in 2013.
As sensitive and deeply personal topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality. The critical importance of client confidentiality—and the limited circumstances in which it may need to be broken for the protection of clients or others—is enshrined in the regulatory psychotherapeutic organizations' codes of ethical practice.Ethical Principles (2010) of the American Psychological Association, Standard 4: Privacy and Confidentiality online at . Examples of when it is typically accepted to break confidentiality include when the therapist has knowledge that a child or elder is being physically abused; when there is a direct, clear and imminent threat of serious physical harm to self or to a specific individual. In some countries psychotherapists are required by law to be mandated reporters.
Europe