Psychotherapy fundamentals

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. 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.