What is Psychotherapy?
Learn about psychotherapy.
Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.
Problems helped by psychotherapy include difficulties in coping with daily life; the impact of trauma, medical illness or loss, like the death of a loved one; and specific mental disorders, like depression or anxiety. There are several different types of psychotherapy and some types may work better with certain problems or issues. Psychotherapy may be used in combination with medication or other therapies.
Therapy Sessions
Therapy may be conducted in an individual, family, couple, or group setting, and can help both children and adults. Sessions are typically held once a week for about 30 to 50. Both patient and therapist need to be actively involved in psychotherapy. The trust and relationship between a person and his/her therapist is essential to working together effectively and benefiting from psychotherapy.
Psychotherapy can be short-term (a few sessions), dealing with immediate issues, or long-term (months or years), dealing with longstanding and complex issues. The goals of treatment and arrangements for how often and how long to meet are planned jointly by the patient and therapist.
Confidentiality is a basic requirement of psychotherapy. Also, although patients share personal feelings and thoughts, intimate physical contact with a therapist is never appropriate, acceptable, or useful.
Psychotherapy and Medication
Psychotherapy is often used in combination with medication to treat mental health conditions. In some circumstances medication may be clearly useful and in others psychotherapy may be the best option. For many people combined medication and psychotherapy treatment is better than either alone. Healthy lifestyle improvements, such as good nutrition, regular exercise and adequate sleep, can be important in supporting recovery and overall wellness.
Does Psychotherapy Work?
Research shows that most people who receive psychotherapy experience symptom relief and are better able to function in their lives. About 75 percent of people who enter psychotherapy show some benefit from it.1 Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction.
With the use of brain imaging techniques researchers have been able to see changes in the brain after a person has undergone psychotherapy. Numerous studies have identified brain changes in people with mental illness (including depression, panic disorder, PTSD and other conditions) as a result of undergoing psychotherapy. In most cases the brain changes resulting from psychotherapy were similar to changes resulting from medication.2
To help get the most out of psychotherapy, approach the therapy as a collaborative effort, be open and honest, and follow your agreed upon plan for treatment. Follow through with any assignments between sessions, such as writing in a journal or practicing what you’ve talked about.
Types of Psychotherapy
Psychiatrists and other mental health professionals use several types of therapy. The choice of therapy type depends on the patient’s particular illness and circumstances and his/her preference. Therapists may combine elements from different approaches to best meet the needs of the person receiving treatment.
- Cognitive behavioral therapy (CBT) helps people identify and change thinking and behavior patterns that are harmful or ineffective, replacing them with more accurate thoughts and functional behaviors. It can help a person focus on current problems and how to solve them. It often involves practicing new skills in the “real world.” CBT can be helpful in treating a variety of disorders, including depression, anxiety, trauma related disorders, and eating disorders. For example, CBT can help a person with depression recognize and change negative thought patterns or behaviors that are contributing to the depression.
- Interpersonal therapy (IPT) is a short-term form of treatment. It helps patients understand underlying interpersonal issues that are troublesome, like unresolved grief, changes in social or work roles, conflicts with significant others, and problems relating to others. It can help people learn healthy ways to express emotions and ways to improve communication and how they relate to others. It is most often used to treat depression.
- Dialectical behavior therapy is a specific type of CBT that helps regulate emotions. It is often used to treat people with chronic suicidal thoughts and people with borderline personality disorder, eating disorders and PTSD. It teaches new skills to help people take personal responsibility to change unhealthy or disruptive behavior. It involves both individual and group therapy.
- Psychodynamic therapy is based on the idea that behavior and mental well-being are influenced by childhood experiences and inappropriate repetitive thoughts or feelings that are unconscious (outside of the person’s awareness). A person works with the therapist to improve self-awareness and to change old patterns so he/she can more fully take charge of his/her life.
- Psychoanalysis is a more intensive form of psychodynamic therapy. Sessions are typically conducted three or more times a week.
- Supportive therapy uses guidance and encouragement to help patients develop their own resources. It helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. Supportive psychotherapy helps patients deal with issues related to their mental health conditions which in turn affect the rest of their lives.
Additional therapies sometimes used in combination with psychotherapy include:
- Animal-assisted therapy – working with dogs, horses or other animals to bring comfort, help with communication and help cope with trauma
- Creative arts therapy – use of art, dance, drama, music and poetry therapies
- Play therapy – to help children identify and talk about their emotions and feelings
Finding and Choosing a Psychotherapist
Psychotherapy can be provided by a number of different types of professionals including psychiatrists, psychologists, licensed social workers, licensed professional counselors, licensed marriage and family therapists, psychiatric nurses, and others with specialized training in psychotherapy. Psychiatrists are also trained in medicine and are able to prescribe medications.
Finding a psychiatrist or other therapist with whom an individual can work well is important. Sources of referrals include primary care physicians, local psychiatric societies, medical schools, community health centers, workplace Employee Assistance Programs (EAP), and online resources (see links to online locators below).
Federal law requires that in most cases mental health services, including psychotherapy, be covered by health insurance similar to other medical care costs. (Read more about insurance coverage of mental health care)
Online Locators for Psychotherapy/Counseling:
References
- American Psychological Association. Understanding psychotherapy and how it works. 2016.
- Karlsson, H. How Psychotherapy changes the Brain. Psychiatric Times. 2011.
- Wiswede D, et al. 2014. Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli. PLoS ONE. 2014.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109037
Physician Review
Ranna Parekh, M.D., M.P.H.
Lior Givon, M.D., Ph.D.
January 2019
Mental Health Treatment Among Adults: United States, 2019
NCHS Data Brief No. 380, September 2020
PDF Versionpdf icon (703 KB) | Visual Abstract
Key findings
Data from the National Health Interview Survey
- In 2019, 19.2% of adults had received any mental health treatment in the past 12 months, including 15.8% who had taken prescription medication for their mental health and 9.5% who received counseling or therapy from a mental health professional.
- Women were more likely than men to have received any mental health treatment.
- Non-Hispanic white adults (23.0%) were more likely than non-Hispanic black (13.6%) and Hispanic (12.9%) adults to have received any mental health treatment.
- Overall, as the level of urbanization decreased, the percentage of adults who had taken medication for their mental health increased, and the percentage who had received counseling or therapy decreased.
In 2018, about 19% of adults experienced any mental illness in the past year, defined as having any mental, behavioral, or emotional disorder in the past year that met criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, or DSM–IV, excluding developmental or substance use disorders (1,2). This report describes the percentage of U.S. adults who have taken prescription medication for their mental health or have received counseling or therapy from a mental health professional in the past 12 months by select characteristics, based on data from the 2019 National Health Interview Survey (NHIS). Estimates are also presented for any mental health treatment, defined as having taken medication for mental health, received counseling or therapy, or both in the past 12 months.
Keywords: medication, counseling and therapy, National Health Interview Survey (NHIS)
The percentage of adults who had received any mental health treatment varied by age group.
Figure 1. Percentage of adults aged 18 and over who had received any mental health treatment, taken medication for their mental health, or received counseling or therapy from a mental health professional in the past 12 months, by age group: United States, 2019
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1Significant quadratic trend by age group (p < 0.05).
2Significant linear trend by age group (p < 0.05).
NOTES: Adults were considered to have received any mental health treatment if they reported having taken medication for their mental health, received counseling or therapy from a mental health professional, or both in the past 12 months. Adults were asked separately if they took prescription medication for feelings of anxiety, for depression, or to help with any other emotions or with their concentration, behavior, or mental health. Adults who responded positively to any of these three questions were considered to have taken medication for their mental health in the past 12 months. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 1pdf icon.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.
Women were more likely than men to have received any mental health treatment.
- Nearly one in four women received any mental health treatment (24.7%) in the past 12 months, compared with 13.4% of men (Figure 2).
- Women were more likely than men to have taken medication for their mental health (20.6% and 10.7%, respectively) and to have received counseling or therapy from a mental health professional (11.7% and 7.2%) in the past 12 months.
Figure 2. Percentage of adults aged 18 and over who had received any mental health treatment, taken medication for their mental health, or received counseling or therapy from a mental health professional in the past 12 months, by sex: United States, 2019
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1Significantly different from women (p < 0.05).
NOTES: Adults were considered to have received any mental health treatment if they reported having taken medication for their mental health, received counseling or therapy from a mental health professional, or both in the past 12 months. Adults were asked separately if they took prescription medication for feelings of anxiety, for depression, or to help with any other emotions or with their concentration, behavior, or mental health. Adults who responded positively to any of these three questions were considered to have taken medication for their mental health in the past 12 months. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 2pdf icon.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.
The percentage who had received any mental health treatment was highest among non-Hispanic white adults.
- Non-Hispanic white adults were most likely to have received any mental health treatment in the past 12 months (23.0%) compared with other race and Hispanic-origin groups (Figure 3).
- Non-Hispanic white adults (19.1%) were more likely than non-Hispanic black (11.1%) and Hispanic (10.3%) adults to have taken medication for their mental health.
- Non-Hispanic white adults (10.9%) were also most likely to have received counseling or therapy compared with the other race and Hispanic-origin groups.
- Non-Hispanic black adults (8.1%) were more likely to have received counseling or therapy compared with Hispanic adults (6.6%).
Figure 3. Percentage of adults aged 18 and over who had received any mental health treatment, taken medication for their mental health, or received counseling or therapy from a mental health professional in the past 12 months, by race and Hispanic origin: United States, 2019
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1Significantly different from non-Hispanic white adults (p < 0.05).
2Significantly different from non-Hispanic black adults (p < 0.05).
NOTES: Adults were considered to have received any mental health treatment if they reported having taken medication for their mental health, received counseling or therapy from a mental health professional, or both in the past 12 months. Adults were asked separately if they took prescription medication for feelings of anxiety, for depression, or to help with any other emotions or with their concentration, behavior, or mental health. Adults who responded positively to any of these three questions were considered to have taken medication for their mental health in the past 12 months. Adults categorized as Hispanic may be of any race or combination of races. Adults categorized as non-Hispanic white or non-Hispanic black indicated one race only. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 3pdf icon.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.
The percentage of adults who had received any mental health treatment varied by urbanization level.
- The percentage of adults who had received any mental health treatment in the past 12 months increased as the place of residence became more rural, from 17.9% among those living in large metropolitan areas to 21.5% among those living in nonmetropolitan areas (Figure 4).
- The percentage of adults who have taken medication for their mental health also increased as the place of residence became more rural, from 14.2% among those living in large metropolitan areas to 18.9% among those living in nonmetropolitan areas.
- The percentage of adults who received counseling or therapy from a mental health professional in the past 12 months was lower in nonmetropolitan areas (7.8%) compared with medium or small metropolitan areas (9.9%) and large metropolitan areas (9.7%).
Figure 4. Percentage of adults aged 18 and over who had received any mental health treatment, taken medication for their mental health, or received counseling or therapy from a mental health professional in the past 12 months, by urbanization level: United States, 2019
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1Significant linear trend by urbanization level (p < 0.05).
2Significant quadratic trend by urbanization level (p < 0.05).
NOTES: Adults were considered to have received any mental health treatment if they reported having taken medication for their mental health, received counseling or therapy from a mental health professional, or both in the past 12 months. Adults were asked separately if they took prescription medication for feelings of anxiety, for depression, or to help with any other emotions or with their concentration, behavior or mental health. Adults who responded positively to any of these three questions were considered to have taken medication for their mental health in the past 12 months. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 4pdf icon.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.
Summary
In 2019, 19.2% of U.S. adults received any mental health treatment in the past 12 months, including 15.8% who had taken prescription medication for their mental health and 9.5% who had received counseling or therapy from a mental health professional. While the percentage of adults who had taken medication for their mental health increased with age, the percentage who had received counseling or therapy decreased with age.
Women were more likely than men to have received any treatment for their mental health, consistent with the higher prevalence of common mental health conditions, such as anxiety and depression, seen among women (3) as well as an increased willingness to seek mental health care (4). Receipt of any mental health treatment was higher among non-Hispanic white adults compared with non-Hispanic black and Hispanic adults. While the percentage of adults who had received counseling or therapy decreased as level of urbanization decreased, the percentage who had taken medication for their mental health increased with decreasing urbanization level.
The findings shown are consistent with previous studies regarding differences by age in medication use and receipt of mental health care (4,5), disparities by race and ethnicity (6), and differences by urbanization level. Past research has shown that nonmetropolitan, or more rural, counties have a lower supply of mental health professionals per capita (7) but a higher prevalence of adults who had experienced a mental illness compared with metropolitan, or more urban, counties (8).
Definitions
Any mental health treatment: A composite measure of adults who reported having taken medication for their mental health, received counseling or therapy from a mental health professional, or both in the past 12 months.
Race and Hispanic origin: Adults categorized as Hispanic may be of any race or combination of races. Adults categorized as non-Hispanic white or non-Hispanic black indicated one race only.
Received therapy or counseling, past 12 months: Based on a positive response to the question, “During the past 12 months, did you receive counseling or therapy from a mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?”
Taken medication for mental health, past 12 months: Sample adults were asked how often they felt worried, nervous, or anxious, followed by the question, “Do you take prescription medication for these feelings?” They were also asked how often they felt depressed, followed by, “Do you take prescription medication for depression?” Those who answered that they did not take medication for feelings of either anxiety or depression (or who did not know or refused to answer these two questions) were later asked, “During the past 12 months, did you take prescription medication to help you with any other emotions or with your concentration, behavior, or mental health?” Adults who responded positively to any of these three questions were considered to have taken medication for their mental health in the past 12 months.
Urbanization level: Metropolitan size and status was determined using the 2013 NCHS urban–rural classification scheme for counties (9), by merging the geographic federal information processing standard (FIPS) codes for the county of household residence with the county-level FIPS codes from the classification scheme’s data set. Large metropolitan includes large central and large fringe metropolitan counties. Medium or small metropolitan includes medium and small metropolitan counties. Nonmetropolitan includes micropolitan and noncore counties
Data source and methods
Data from the 2019 NHIS were used for this analysis. NHIS is a nationally representative household survey of the U.S. civilian noninstitutionalized population. It is conducted continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews are conducted in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. For more information about NHIS, visit: https://www.cdc.gov/nchs/nhis.htm.
Point estimates and the corresponding confidence intervals for this analysis were calculated using SUDAAN software (10) to account for the complex sample design of NHIS. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Trends by age group and urbanization level were evaluated using orthogonal polynomials in logistic regression. All estimates meet NCHS data presentation standards for proportions (11).
About the authors
Emily P. Terlizzi and Benjamin Zablotsky are with the National Center for Health Statistics, Division of Health Interview Statistics.
References
Suggested citation
Terlizzi EP, Zablotsky B. Mental health treatment among adults: United States, 2019. NCHS Data Brief, no 380. Hyattsville, MD: National Center for Health Statistics. 2020.
Copyright information
All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
National Center for Health Statistics
Brian C. Moyer, Ph.D., Director
Amy M. Branum, Ph.D., Acting Associate Director for Science
Division of Health Interview Statistics
Stephen J. Blumberg, Ph.D., Director
Anjel Vahratian, Ph.D., M.P.H., Associate Director for Science
