How Does Therapy Work?

A psychologist explains the ins and outs of therapy, from what to expect during sessions to how to choose the right therapist.

For a long time, the word “therapy” carried a lot of stigma, and people who sought professional mental health services would avoid talking openly about it out of shame or embarrassment.

But as awareness of the importance of mental health has grown, therapy has become more normalized — and accepted as a way of maintaining a person’s health and well-being. According to a 2022 Gallup poll, about 23% of U.S. adults have seen a mental health professional, up from 13% in 2004.

“Therapy can be an incredible experience that changes lives,” says Dr. Jesse Allen-Dicker, a clinical psychologist at NewYork-Presbyterian/Weill Cornell Medical Center. “Just like how you would see a doctor for a physical health need, talking to a professional for mental health is also important.”

Health Matters spoke to Dr. Allen-Dicker to better understand the basics of therapy, including the benefits, types of therapy, and how to find a therapist. He also offers tips on deciding if your therapist is the right fit for you and how to make the most of your sessions.

Dr. Jesse Allen-Dicker

What is therapy?
Dr. Allen-Dicker: Psychotherapy, also known as talk therapy, is a treatment that involves speaking with a therapist in order to receive support and process the interaction between your thoughts, your feelings, and your behaviors. It can also help you make constructive changes in those areas. Therapy can look different from provider to provider; it also depends on the type of therapy.

What are the benefits of going to therapy?
The benefits of therapy vary from case to case, both in the sense of what’s leading a person to seek treatment, as well their past experiences and motivation for treatment.

Therapy is an effective treatment for individuals with many psychiatric diagnoses, like anxiety disorders, obsessive compulsive disorder, or major depressive disorder, either on its own or in conjunction with psychiatric medication.

But even for life scenarios, such as when a person is facing big life transitions or relationship challenges, therapy can be a helpful place for individuals to receive support and flesh out these situations to help inform their decision-making.

What are some common types of therapy?
There are many different approaches to therapy. The two largest schools of thought are cognitive behavioral therapy and psychodynamic psychotherapy.

Cognitive behavioral therapy is an umbrella term that includes other forms of therapy like dialectical behavior therapy, but in general, it focuses on addressing patient challenges with psychoeducation and skill building. The therapist might assign “homework assignments” so that patients can practice those skills in between sessions. After completing treatment, patients may occasionally return for “maintenance sessions” to freshen up on those skills.

Psychodynamic psychotherapy is much more focused on emotions and relationships, especially as they present within the treatment room. Traditionally, it focuses more on one’s past experiences than cognitive behavioral therapy, though approaches vary from provider to provider within each school of thought.

Sessions can be in person or virtual, depending on personal preference and availability. While there are some nuances that might be lost in virtual sessions, both forms of treatment can be highly effective.

Who is therapy for?
There is a common misconception that therapy is only for those with severe emotional disorders. While it can certainly help address significant trauma or serious psychiatric illness, it also can be a tremendous outlet for individuals experiencing a life change or a recent onset of stress or anxiety.

Anyone can benefit from therapy if they are interested in participating. It can help maintain and strengthen your mental health, much like seeing a primary medical doctor or going to the gym helps upkeep your physical health.

Therapy and mental health are being discussed on social media more and more, which can be a double-edged sword. If people feel supported through hearing the stories or advice of others, that’s wonderful. But I would caution people to avoid self-diagnosis based on social media, and instead express their concerns with psychiatric providers. Similarly, people should not take views or recommendations from influencers as facts, as their statements may not be accurate or may not be applicable or beneficial to all individuals.

"Therapy can be a helpful place for individuals to receive support and flesh out situations to help inform their decision-making."

— Dr. Jesse Allen-Dicker

How much does therapy usually cost?
The financial cost associated with therapy varies depending a patient’s insurance coverage and preference, as well as provider offerings.

Unfortunately, it can be difficult for some to access therapy due to cost or lack of providers. However, in recent years the field has worked hard to help expand services through offering a variety of pricing structures and treatment modalities.

What is the difference between a therapist versus a psychologist or psychiatrist?
Although providers may have varying backgrounds or degrees, the term “therapist” can refer to any psychologist, psychiatrist, or social worker who provides psychotherapy.

The nature of the work of psychologists, psychiatrists, and social workers vastly varies from provider to provider; however, in general, the focus of their work is often influenced by their disciplines and the training they received. In short, if given the appropriate training, all three can provide an array of psychotherapies.

In addition, psychiatrists often can provide psychiatric medications, while psychologists often can provide psychological testing, while social workers are often better trained to help patients navigate community-based or government-based systems.

How should someone go about finding a therapist?
First, I’d recommend reflecting on the kinds of specific challenges you’re facing, how you typically receive information best, and what is most important to you in the treatment process.

From there, it can be helpful to go online and read up on the various forms of therapy, to see which approach might be most in line with what you’re looking for. There are many websites that help connect patients with mental health providers, and you can check which providers might be covered by your insurance. Of course, speaking with your primary care physician is also a great starting point.

Once you’ve decided on a style of therapy, it’s important to find a therapist that you’re compatible with and who you feel you can trust. It might take several tries to find the right therapist for you.

I would recommend giving it a few sessions before deciding whether to stay with a therapist, but if you do feel like your therapist is not the right fit, I recommend speaking openly and honestly with them – whether you’re having doubts about the treatment itself or specific aspects you don’t like.

Therapy is almost always a voluntary process, so it’s best to communicate with the provider to see how they respond and if those issues can be worked out. If it seems like they can’t and you’ve made up your mind, it’s OK to move on and try a different provider.

Is therapy confidential?
Traditional outpatient psychotherapy is confidential. That is, everything discussed during your session is between you and your therapist unless something that you share raises concern for your safety or the safety of someone else.

However, confidentiality in therapy may vary for minors, as well as individuals in larger clinics or mandated treatments.

How long, and how frequently, should someone see a therapist?
The frequency and amount of time someone should remain in therapy varies based on the individual and their needs.

Often, we recommend weekly 45-minute sessions, though some patients or providers prefer longer sessions or may have sessions twice a week or more. Many times, the patient and therapist will eventually transition to a lower frequency (every two weeks, for example) after a certain degree of progress.

As far as duration of overall treatment, it depends on the patient’s goals and progress, as well as the treatment approach. Some people can experience symptom relief in six to 12 sessions, while others can remain in therapy for years; and one isn’t necessarily “better” than the other.

Being vulnerable isn’t easy, and seeing a therapist might mean pushing yourself outside of your comfort zone. But therapy can be an incredibly worthwhile and empowering experience, and the more honest, engaged, and vulnerable you are within your treatment, the more successful it is likely to be.

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