Starting therapy: a beginner's guide

Therapy, also called talk therapy or psychotherapy, means meeting with a trained professional to work on troubling feelings, thoughts and habits. It is one of the two most common treatments for mental health problems. The other is medicine.¹

Many people put off therapy because they do not know what to expect. This guide explains who does therapy, what happens at the first visit, how long it takes, and how well it works. It also links to our pages on finding a therapist, paying for it, online options and support groups.

What therapy is and is not

Therapy is not just chatting, and it is not advice from a friend. A good therapist uses methods that have been tested in research. These may include learning to spot unhelpful thoughts, practicing coping and problem-solving skills, relaxation, and tracking your mood.¹

There are many styles. Some of the best studied are CBT, behavioral activation, problem-solving therapy and interpersonal therapy. You can compare them on our therapies overview.

Unlike medicines, therapies do not go through FDA approval. That is why it helps to ask a therapist which method they use and what research supports it.¹

Therapy can be used alone or together with medicine. A health care provider should first check for physical causes of your symptoms, such as a thyroid problem or a side effect of a medicine.¹

Types of mental health professionals

The letters after a name tell you about a person's training. Each type is licensed by the state. Here is a plain guide.²

Family doctors and some pharmacists can also prescribe mental health medicines.² Many people see a therapist for talk therapy and a doctor or nurse practitioner for medicine.

A psychologist is not better than a counselor just because of the longer degree. What matters most is training in a method that fits your problem, experience with people like you, and a good working relationship.³

What the first session is like

Before you commit, many therapists offer a short phone or video call. Use it to see if you feel comfortable with them.¹

At the first full session, expect some paperwork. Sessions usually last about 45 to 50 minutes.³ The therapist will likely ask:

• What brings you in, and what you hope will change
• Your health, your family history and your daily life
• Who supports you, such as family, friends or faith community

They will also explain fees, scheduling and privacy. After the first few sessions, you should have a clearer picture of the problem and a plan.³

Privacy

What you say in therapy is private. There are a few exceptions. A therapist must act if you are at risk of harming yourself or someone else. They must also report abuse or neglect of a child, an older adult or a person with a disability.³ You can give written permission for them to talk with your doctor or family.

Questions you can ask

NIMH suggests asking questions like these:¹

1. What are your training, license and specialties?
2. What method do you use, and what research supports it for my problem?
3. Have you worked with people my age with this problem?
4. How many sessions do you expect, and how will we know if it is working?
5. Can you prescribe medicine, or who would I see for that?
6. What do you charge? Do you take my insurance or Medicare? Do you have a sliding scale?

How many sessions will I need?

There is no single answer. Some people feel some relief after one session. Many begin to feel better in about 6 to 12 sessions. People with past trauma, several problems, or a serious mental illness may need a year or more, or ongoing care.³

One classic study found that about half of people improved after 8 sessions, and about 3 in 4 improved after six months.³ Many therapists set a goal and a rough number of sessions at the start.

If you are not feeling any better after a reasonable time, say so. Your therapist may change the approach. You can also try a different therapist or method.¹ Switching is normal and is not rude.³

Does therapy work?

Yes, for many people and many problems. The strongest research is for depression and anxiety.

A large 2023 review pooled 409 studies with more than 52,000 people with depression. It found that CBT clearly helped compared with usual care or a waiting list. The benefit lasted at 6 to 12 months.⁶

In the same review, CBT worked about as well as antidepressant medicine at first. A few studies suggested CBT held up a bit better over the following year. Combining CBT with medicine worked better than medicine alone.⁶ Your doctor can help you decide which fits you. See treatment for depression and treatment for anxiety.

The relationship with your therapist matters a great deal. Feeling understood and working as a team is one of the main reasons therapy helps.³

Therapy in later life

Age is not a barrier. Research supports talk therapy for older adults, including CBT and brief therapies for depression, CBT for sleep problems and worry, and life review for low mood.⁷ For late-life depression, therapy has worked about as well as antidepressants in studies.⁷

Older adults may face hurdles such as getting to appointments, hearing problems, cost, or a feeling that therapy is "not for my generation." Phone sessions, video visits and home visits can help.⁷

A good place to start is your primary care provider, who can refer you.⁸ Medicare Part B covers outpatient therapy from psychiatrists, psychologists, clinical social workers, nurse practitioners, marriage and family therapists and mental health counselors. After the yearly deductible, you usually pay 20% of the approved amount. The yearly depression screening costs nothing if your provider accepts Medicare's rate.⁴ Coverage for marriage and family therapists and mental health counselors began January 1, 2024.⁵ See more on our older adults page.

Your next steps

These pages walk you through the practical parts:

• How to find a therapist: directories, insurance lists, Medicare, telehealth, language match and red flags
• Paying for therapy: insurance, Medicare, Medicaid, employee programs and low-cost clinics
• Online therapy and mental health apps: what the research says, FDA-cleared apps and privacy
• Support groups and peer support: groups for people and families, and peer specialists

Not sure where you stand? Try our check-in.

In this section

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.