Talk therapy offers two advantages over medication: no drug side effects and tools you can use for the long term.
“When you take medication, you stop the medication and the problem may come back,” says Michael First, M.D., professor of clinical psychiatry at Columbia University. “When you have a run of cognitive behavioral therapy, you actually learn a skill. It’s something that sticks with you.”
Going to therapy requires a time commitment, and the insurance claims process might be more cumbersome than with medications. Still, if your plan will pay or you can swing the out-of-pocket portion of the cost, our survey suggests it’s an investment worth making. Of the respondents who visited a mental-health professional for talk therapy, either alone or in conjunction with taking medication, 46 percent said the therapists had made things “a lot better” and 45 percent said they had made things “somewhat better.”
That finding was consistent regardless of whether the person had seen a psychologist, a social worker, or a licensed counselor. Helpfulness scores were somewhat higher for people who had seen a psychiatrist, a medical doctor who can prescribe medication. Of patients who went to psychiatrists, 59 percent received some talk therapy, usually in combination with medication; the rest got only meds. (We also asked people if they had seen psychiatric nurses, practitioners who specialize in mental health and, in some states, can prescribe medications on their own. But only 2 percent of our respondents got their care from nurses, too few to be included in our analysis.) In two states, appropriately trained psychologists have a limited authority to prescribe medications, but in general psychologists typically specialize in talk therapy.
How long and what kind
People who stuck with talk therapy for at least seven sessions had significantly better outcomes than those who went to six or fewer sessions (see Talk vs. Meds vs. Both). What’s more, they scored as high as people treated mostly with medication on our overall outcome scale, which combined respondents’ perceptions of their provider’s helpfulness, satisfaction with their treatment, and change in their self-reported mental-health status after treatment.
Depending on the severity of your symptoms, therapy may be a good first step; you can always talk to your therapist about adding medication later if needed. The best-studied talk therapy is cognitive-behavioral therapy, or CBT, in which you learn to recognize and change thoughts or behaviors that contribute to your distress. Many therapists practice a hybrid approach that may combine aspects of CBT with other strategies. Some research suggests that the quality of your relationship with your therapist, regardless of the degree on the wall or the style of treatment, is an important key to success. So put your energy into finding a compatible one.
What to do
Our past surveys have shown that people who find a therapist through a recommendation from a friend, family member, or doctor have more success than those who pick someone at random from the phone book or their health plan’s provider directory. If you can’t find one that way, try the online therapist finders at the Association for Behavioral and Cognitive Therapies, the Anxiety Disorders Association of America, or the American Psychological Association, or check with the employee assistance program at your workplace.
When you’re interviewing possible therapists, these questions can help you determine whether it’s a good fit:
- How much experience do you have treating people with issues like mine?
- What is your degree, and what state license do you hold?
- What’s your basic approach to treatment? What sorts of methods do you use?
- How soon can you see me? (If the situation is critical and the therapist has no openings, ask for a referral.)
- What are your fees, and do you take my insurance? (For more on payment, see How to pay.)