Frequently Asked Questions

Rehab (residential treatment) provides 24/7 structured care in a facility, typically for 30 to 90 days, and is usually recommended for severe addiction or when a person needs a safe environment to detox and stabilize. Outpatient therapy involves regular sessions (weekly or more often) while you continue living at home. Many people step down from rehab to outpatient therapy, and others start with outpatient therapy without ever needing a residential stay.

Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and Contingency Management have the strongest evidence for treating substance use disorders. CBT helps you identify and change the thought patterns and situations that trigger use. MI helps you resolve ambivalence about change. The best approach depends on the substance, severity of use, and any co-occurring mental health conditions. Many therapists combine multiple evidence-based techniques.

No. You do not need to be sober to begin therapy. In fact, therapy can help you get to sobriety if that is your goal. Many therapists work with clients who are actively using substances, meeting them where they are and helping them move toward reducing or stopping use. Some approaches, like harm reduction therapy, do not require abstinence as a precondition for treatment.

Medication-assisted treatment (MAT) combines FDA-approved medications — such as buprenorphine, methadone, or naltrexone — with therapy and counseling. MAT is considered the gold standard for opioid use disorder and is also effective for alcohol use disorder. Research consistently shows that MAT reduces substance use, overdose deaths, and criminal activity while improving treatment retention. MAT is not replacing one addiction with another — it is evidence-based medicine.

There is no fixed timeline. Acute treatment may last 3 to 6 months, but recovery is an ongoing process. Many people benefit from continued therapy, support groups, or check-in sessions for a year or longer after initial treatment. Research shows that longer engagement in treatment is associated with better outcomes. Your treatment team will help you develop a long-term plan that evolves as your recovery progresses.

No. Relapse is a common part of the recovery process, not a sign of failure. Addiction is a chronic condition, and like other chronic conditions (such as diabetes or hypertension), setbacks can occur. What matters is how you respond. A relapse is an opportunity to identify what triggered it, strengthen your coping strategies, and adjust your treatment plan. Many people who ultimately achieve lasting recovery have experienced one or more relapses along the way.

Yes. While Alcoholics Anonymous and other 12-step programs help many people, they are not the only path to recovery. Evidence-based therapies like CBT, Motivational Interviewing, and medication-assisted treatment are effective alternatives. Some people combine therapy with non-12-step support groups like SMART Recovery or Moderation Management. The best approach is the one that works for you.

Family involvement can significantly improve treatment outcomes. Addiction affects the entire family system, and family therapy helps repair relationships, establish healthy boundaries, and reduce enabling behaviors. Approaches like Community Reinforcement and Family Training (CRAFT) are specifically designed to help family members support a loved one's recovery. However, family involvement should always be voluntary and handled with sensitivity.

The scientific consensus is that addiction is a chronic brain condition, not a moral failing. While the initial decision to use a substance may be voluntary, repeated use changes brain chemistry and circuitry in ways that make stopping extremely difficult. This is why willpower alone is rarely sufficient and why evidence-based treatment — including therapy and sometimes medication — is so important. Understanding addiction as a medical condition reduces stigma and opens the door to effective treatment.

Therapy sessions are confidential, and your therapist cannot share information about your substance use with employers, family members, or law enforcement without your written consent. Federal regulation 42 CFR Part 2 provides additional confidentiality protections specifically for substance use treatment records. The main exceptions to confidentiality are the same as in any therapy setting: imminent danger to yourself or others, and mandated reporting of child or elder abuse.

Dual diagnosis means having both a substance use disorder and another mental health condition, such as depression, anxiety, PTSD, or bipolar disorder. This is extremely common — roughly half of people with a substance use disorder also have a co-occurring mental health condition. Integrated treatment that addresses both conditions simultaneously produces much better outcomes than treating them separately. When looking for a therapist, ask whether they have experience with co-occurring disorders.

Both medication and therapy are effective for ADHD, and many people benefit from a combination of the two. Medication primarily helps with core symptoms like inattention and impulsivity, while therapy addresses the habits, coping strategies, and emotional challenges that come with living with ADHD. For mild symptoms or for people who prefer not to use medication, therapy and behavioral strategies can make a significant difference on their own.

Cognitive Behavioral Therapy (CBT) adapted for ADHD is the most well-supported therapeutic approach for adults and older teens. It focuses on practical skills like time management, organization, task initiation, and managing the frustration and self-criticism that often accompany ADHD. For children, behavioral parent training and classroom interventions are typically the first-line treatments.

Absolutely. ADHD is a lifelong condition, and many people are not diagnosed until adulthood. Therapy for adult ADHD is specifically designed to address challenges like workplace performance, relationship difficulties, financial management, and the emotional toll of years of undiagnosed symptoms. It is never too late to get support.

ADHD is a chronic condition, but the level of treatment you need may change over time. Some people use medication and therapy intensively for a period and then step down to occasional check-ins and self-management strategies. Others benefit from ongoing support. The goal is to build skills and systems that help you function well, and the amount of professional support required varies from person to person.

ADHD coaching focuses on practical strategies — organization, time management, goal setting, and accountability. Therapy goes deeper, addressing the emotional and psychological impacts of ADHD such as anxiety, depression, low self-esteem, and relationship difficulties. Coaching can be a helpful complement to therapy, but it is not a substitute when mental health concerns are present. Coaches are typically not licensed mental health professionals.

Yes. Therapy can help you develop compensatory strategies for executive function challenges, address negative thought patterns that have built up over time, and improve your ability to manage daily responsibilities. While medication can make it easier to implement these strategies, therapy without medication still produces meaningful improvements for many people.

ADHD often presents differently in women and girls, who are more likely to have the inattentive type rather than the hyperactive-impulsive type. This can look like daydreaming, difficulty staying organized, or quietly struggling to keep up rather than the disruptive behavior commonly associated with ADHD. As a result, women and girls are frequently diagnosed later in life. A therapist familiar with how ADHD presents across genders can ensure accurate assessment and appropriate treatment.

Therapy helps you build external systems and habits to compensate for executive function challenges like planning, prioritizing, starting tasks, and managing time. A therapist may help you set up structured routines, break large tasks into smaller steps, use visual reminders and timers, and develop strategies for transitions between activities. Over time, these compensatory skills become more automatic.

ADHD can significantly impact relationships through difficulties with listening, follow-through, emotional regulation, and seeming unreliable or inattentive to a partner. Therapy can help you understand how ADHD affects your relational patterns and develop strategies for better communication and accountability. Couples therapy with a therapist who understands ADHD can be especially valuable for addressing the dynamic between partners.

Cognitive Behavioral Therapy (CBT) is considered the gold standard for treating anxiety disorders and has the strongest research support. Other effective approaches include Acceptance and Commitment Therapy (ACT), Exposure and Response Prevention (ERP) for OCD-related anxiety, and EMDR for trauma-related anxiety. Your therapist will recommend the best approach based on your specific type of anxiety and symptoms.

Most people begin noticing improvement within 6 to 8 sessions of CBT. A typical full course of treatment runs 12 to 20 weekly sessions, though some people benefit from fewer and others with complex or long-standing anxiety may need more. Your therapist will develop a timeline tailored to your situation and adjust it as you progress.

Therapy does not eliminate anxiety entirely because anxiety is a normal and sometimes useful human emotion. However, therapy can dramatically reduce the frequency, intensity, and impact of anxiety on your daily life. Many people who complete treatment report that anxiety no longer controls their decisions or interferes with work, relationships, or enjoyment of life. The skills you learn in therapy continue to protect you long after treatment ends.

Many people improve significantly with therapy alone, especially for mild-to-moderate anxiety. For moderate-to-severe anxiety, combining therapy with medication (typically an SSRI or SNRI) is often the most effective approach. Medication can reduce symptoms enough for you to fully engage in the therapeutic work. This is a decision to make collaboratively with your therapist and prescribing provider.

Yes. Research consistently shows that online CBT for anxiety is as effective as in-person therapy. Video-based sessions with a licensed therapist offer the same structured treatment in a more convenient format. Online therapy can be especially helpful if anxiety about leaving the house or being in social situations is part of the problem.

Therapy is highly effective for panic attacks. CBT and exposure-based treatments help you understand what triggers your panic, learn that the physical sensations are not dangerous, and develop tools to respond differently when panic arises. Many people who complete treatment for panic disorder experience a significant reduction in both the frequency and severity of attacks.

Costs vary depending on your location, therapist credentials, and insurance coverage. With insurance, copays typically range from $20 to $75 per session. Without insurance, expect $100 to $250 per session. Many therapists offer sliding scale fees, and community mental health centers and university training clinics provide more affordable alternatives.

Absolutely. Anxiety disorders are among the most common mental health conditions in children and adolescents, and early treatment is especially effective. CBT has strong evidence for youth anxiety, and therapists who work with young people adapt the approach to be age-appropriate. Parent involvement is often part of the treatment, particularly for younger children.

There is no minimum threshold for seeking therapy. If anxiety is causing you distress, keeping you from doing things that matter to you, or interfering with work, school, or relationships, therapy can help. You do not need a clinical diagnosis to benefit, and many people who seek help for what they consider mild anxiety find it tremendously valuable.

In a typical CBT session for anxiety, you review your week, discuss any homework from the previous session, and work on a specific skill — such as identifying anxious thought patterns, practicing relaxation techniques, or doing a gradual exposure exercise. Sessions are structured and collaborative, usually lasting about 50 minutes. Your therapist guides the process, but you are an active participant throughout.

Yes. Anxiety commonly produces physical symptoms including chest tightness, nausea, dizziness, headaches, muscle tension, shortness of breath, and stomach problems. These symptoms are real and can be alarming, but they are your body's stress response in overdrive. Therapy helps you understand the connection between anxiety and physical sensations and teaches you techniques to calm your nervous system.

It is common for anxiety to temporarily increase when you start confronting the things you have been avoiding — this is actually a sign that the treatment is engaging the right issues. Exposure-based therapies intentionally bring up anxiety in a controlled way so you can learn to tolerate it. If you feel overwhelmed or unsafe at any point, tell your therapist immediately so they can adjust the pace.

Traditional CBT focuses on identifying and changing unhelpful thought patterns and behaviors, while Dialectical Behavior Therapy (DBT) adds skills for emotional regulation, distress tolerance, and mindfulness. DBT was originally developed for borderline personality disorder but is now used for a range of conditions involving intense emotions. Learn more on our [DBT page](/treatments/dialectical-behavior-therapy-dbt).

CBT aims to change the content of unhelpful thoughts, whereas Acceptance and Commitment Therapy (ACT) teaches you to accept difficult thoughts and feelings without trying to eliminate them. ACT emphasizes psychological flexibility and living in alignment with your personal values. Both are evidence-based, but they take fundamentally different approaches to the role of thoughts in suffering. See our [ACT page](/treatments/acceptance-and-commitment-therapy-act) for details.

There is no single definitive count, but experts generally recognize at least 15 to 20 distinct approaches within the CBT family. These range from traditional cognitive therapy and behavioral activation to newer forms like ACT, DBT, and metacognitive therapy. The number continues to grow as researchers develop specialized protocols for specific conditions.

Third-wave CBT refers to a newer generation of cognitive behavioral therapies that emphasize mindfulness, acceptance, and the relationship you have with your thoughts rather than directly challenging thought content. Key third-wave approaches include [ACT](/treatments/acceptance-and-commitment-therapy-act), [DBT](/treatments/dialectical-behavior-therapy-dbt), [MBCT](/treatments/mindfulness-based-cognitive-therapy-mbct), and [compassion-focused therapy](/treatments/compassion-focused-therapy). These therapies build on traditional CBT principles while incorporating broader concepts like values, self-compassion, and present-moment awareness.

Traditional CBT with exposure techniques is the most widely researched and recommended approach for most anxiety disorders. For generalized anxiety, standard [CBT](/treatments/cognitive-behavioral-therapy-cbt) is highly effective, while [ERP](/treatments/exposure-and-response-prevention-erp) is the gold standard for OCD-related anxiety. [ACT](/treatments/acceptance-and-commitment-therapy-act) has also shown strong results, particularly for people who struggle with thought suppression strategies.

Standard [CBT](/treatments/cognitive-behavioral-therapy-cbt) and [behavioral activation](/treatments/behavioral-activation) are among the most effective treatments for depression. For preventing depression relapse, [Mindfulness-Based Cognitive Therapy (MBCT)](/treatments/mindfulness-based-cognitive-therapy-mbct) has strong evidence. [Interpersonal psychotherapy (IPT)](/treatments/interpersonal-psychotherapy-ipt), while not strictly CBT, is another well-supported option often compared alongside it.

[Exposure and Response Prevention (ERP)](/treatments/exposure-and-response-prevention-erp) is considered the frontline CBT-based treatment for OCD and has the strongest evidence base. ERP involves gradually facing feared situations while resisting the urge to perform compulsive behaviors. Some therapists also incorporate elements of [ACT](/treatments/acceptance-and-commitment-therapy-act) to help with the acceptance component of treatment.

[Cognitive Processing Therapy (CPT)](/treatments/cognitive-processing-therapy-cpt) and [Prolonged Exposure (PE)](/treatments/prolonged-exposure) are the two CBT-based treatments with the strongest evidence for PTSD. [Trauma-Focused CBT (TF-CBT)](/treatments/trauma-focused-cognitive-behavioral-therapy-tf-cbt) is specifically designed for children and adolescents who have experienced trauma. [EMDR](/treatments/eye-movement-desensitization-and-reprocessing-emdr) is also widely recommended, though it is not technically a CBT variant.

CBT-E (Enhanced Cognitive Behavior Therapy) is the leading evidence-based treatment for eating disorders, including bulimia nervosa and binge eating disorder. For adolescents with anorexia nervosa, family-based treatment is often preferred, though CBT-E can also be effective. [DBT](/treatments/dialectical-behavior-therapy-dbt) skills training has shown promise for binge eating and emotional eating patterns.

[CBT for Insomnia (CBT-I)](/treatments/cognitive-behavioral-therapy-for-insomnia-cbt-i) is a structured program that addresses the thoughts and behaviors contributing to chronic sleep difficulties. It includes techniques like sleep restriction, stimulus control, and cognitive restructuring. CBT-I is considered the first-line treatment for chronic insomnia by the American College of Physicians, and research shows it is more effective than sleep medication in the long term.

[Schema therapy](/treatments/schema-therapy) builds on CBT by targeting deep, long-standing patterns (called schemas) that develop in childhood and persist into adulthood. It integrates CBT techniques with elements of attachment theory, gestalt therapy, and psychodynamic approaches. Schema therapy is particularly helpful for personality disorders, chronic depression, and relationship difficulties that have not responded well to standard CBT.

Metacognitive therapy focuses on changing how you relate to your thoughts rather than changing the thoughts themselves. It targets unhelpful thinking styles like worry and rumination by addressing the beliefs you hold about your own thinking processes. MCT has shown promising results for generalized anxiety disorder and depression, and some studies suggest it may be as effective as or more effective than traditional CBT for certain conditions.

[EMDR](/treatments/eye-movement-desensitization-and-reprocessing-emdr) is not a type of CBT. While both are evidence-based and share some overlapping principles, EMDR uses bilateral stimulation (such as guided eye movements) to help the brain reprocess traumatic memories. EMDR draws from multiple theoretical frameworks, including adaptive information processing theory, and is classified as its own distinct therapeutic approach.

[ERP](/treatments/exposure-and-response-prevention-erp) is actually a specialized form of CBT, not a separate therapy. The key difference is that ERP places heavy emphasis on structured exposure exercises and preventing compulsive responses, making it particularly suited for OCD. Standard CBT may focus more broadly on cognitive restructuring, while ERP prioritizes behavioral change through direct confrontation of feared stimuli.

Yes. CBT is one of the most researched therapies for online delivery, and studies consistently show that internet-based CBT (iCBT) is effective for conditions like anxiety and depression. Many CBT-based programs also offer guided self-help through apps and computerized modules. Live video sessions with a therapist are another widely available option that maintains the interactive element of traditional CBT.

The best type of CBT depends on your specific condition, symptoms, and personal preferences. A qualified therapist can conduct an assessment and recommend the most appropriate approach. As a general guideline, standard CBT works well for anxiety and depression, [ERP](/treatments/exposure-and-response-prevention-erp) is best for OCD, [DBT](/treatments/dialectical-behavior-therapy-dbt) helps with emotional regulation difficulties, and [CPT](/treatments/cognitive-processing-therapy-cpt) or [PE](/treatments/prolonged-exposure) are recommended for trauma.

Most established CBT variants have a solid evidence base, though the strength of evidence varies by specific approach and condition. Traditional CBT, DBT, ACT, ERP, CPT, and prolonged exposure all have extensive research support. Newer approaches like metacognitive therapy and compassion-focused therapy have growing but more limited evidence. Always ask a potential therapist about the research supporting their recommended approach for your particular concerns.

[Trauma-Focused CBT (TF-CBT)](/treatments/trauma-focused-cognitive-behavioral-therapy-tf-cbt) is a structured therapy designed specifically for children and adolescents aged 3 to 18 who have experienced trauma. It combines cognitive behavioral techniques with trauma-sensitive interventions and actively involves a caregiver in the treatment process. TF-CBT has strong research support for treating PTSD, grief, and other trauma-related difficulties in young people.

[Compassion-focused therapy](/treatments/compassion-focused-therapy) is a third-wave CBT approach developed for people who experience high levels of shame and self-criticism. It draws on neuroscience, evolutionary psychology, and Buddhist philosophy to help activate the brain's self-soothing system. CFT is particularly useful for individuals who understand their problems intellectually through traditional CBT but still struggle with deeply entrenched feelings of inadequacy or self-blame.

Most standard [CBT](/treatments/cognitive-behavioral-therapy-cbt) protocols run between 8 and 20 sessions, depending on the condition being treated. Focused protocols like [CBT-I](/treatments/cognitive-behavioral-therapy-for-insomnia-cbt-i) for insomnia may take as few as 4 to 6 sessions, while more complex issues may require longer courses of treatment. Some CBT-based approaches like [schema therapy](/treatments/schema-therapy) and [DBT](/treatments/dialectical-behavior-therapy-dbt) are designed as longer-term treatments, often lasting 6 to 12 months or more.

Confidentiality means that what you share with your therapist stays between you and your therapist. It is both a legal requirement and an ethical obligation. Therapists cannot disclose your identity as a client, what you discuss in sessions, or any information from your records to anyone — including family members, employers, or other professionals — without your written consent. This protection is what allows therapy to be a safe space for honest, vulnerable conversation.

There are a few legally required exceptions. Therapists are mandated reporters, meaning they must break confidentiality if there is an imminent risk of harm to yourself or someone else, if there is suspected abuse or neglect of a child, elderly person, or dependent adult, or if a court issues a valid legal order for your records. Some states have additional exceptions, such as a duty to warn identifiable potential victims of a serious threat. Your therapist will explain these limits clearly at the beginning of treatment.

Mandated reporting is a legal requirement that therapists report suspected child abuse, elder abuse, or abuse of a dependent adult to the appropriate authorities. This does not mean your therapist is looking for reasons to report — it means that if they learn about abuse or neglect during a session, they are legally obligated to act. You can still speak freely in therapy about nearly any topic. If a situation comes close to a reporting threshold, a good therapist will discuss it with you transparently whenever possible.

HIPAA (the Health Insurance Portability and Accountability Act) is a federal law that sets strict standards for how your health information is stored, shared, and protected. Under HIPAA, your therapist must keep your records secure, obtain your consent before sharing information with other providers, and give you the right to access your own records. HIPAA also limits what insurance companies can share with employers. Psychotherapy notes — the personal notes your therapist writes about sessions — have even stronger protections and generally cannot be released without your explicit authorization.

Your insurance company will know that you are receiving therapy, the dates of your sessions, and the diagnosis code your therapist assigns (which is required for billing). They do not receive details about what you discuss in session or your therapist's session notes. If confidentiality around your diagnosis is a major concern — for example, if you would rather not have a mental health diagnosis on your insurance record — you can choose to pay out of pocket and avoid using insurance entirely.

No. Even if you use employer-provided health insurance, HIPAA prohibits your employer from accessing your individual health claims. Your HR department does not see what medical services you use. If you use an Employee Assistance Program (EAP), your participation is also confidential — the EAP provider cannot tell your employer whether you specifically used the service. The only exception would be if you voluntarily disclose it yourself.

Confidentiality for minors is more nuanced. Parents or legal guardians generally have legal access to a minor child's therapy records, but in practice, most therapists working with teens negotiate a confidentiality agreement at the start of treatment. The typical arrangement is that the therapist will keep session content private but will inform parents if there is a safety concern (such as suicidal thoughts, self-harm, or substance abuse). Many states give adolescents the right to consent to their own mental health treatment at a certain age, often 12 to 16, which strengthens their privacy protections.

Confidentiality in couples therapy is handled differently than in individual therapy. Most couples therapists establish a 'no secrets' policy at the outset, meaning if one partner shares something in an individual communication (such as a solo session or phone call), the therapist may not keep it secret from the other partner. This is to prevent the therapist from being put in the position of holding information that could undermine the treatment. Your couples therapist should explain their specific confidentiality policy clearly before treatment begins.

Yes. Under HIPAA, you have the right to request and receive a copy of your therapy records, including clinical notes, treatment plans, and assessments. Your therapist may charge a reasonable fee for copying and can provide the records in electronic or paper format. Psychotherapy notes (the therapist's personal process notes) are treated differently — they have additional protections, and in some cases your therapist is not required to release them, though many will if you ask. The request must typically be made in writing.

Therapists are required by their licensing board and state law to have a plan for records when they close their practice. Records must be stored securely for a set number of years after treatment ends — typically 5 to 10 years for adults and longer for minors, depending on the state. Your therapist should notify you of the closure and let you know how to access your records going forward. In some cases, records are transferred to another therapist or a secure records storage service.

In some circumstances, yes. A valid court order or subpoena can compel a therapist to release records or testify. However, therapist-client privilege (which exists in most states) provides significant protection, and therapists will typically assert privilege on your behalf unless the court specifically overrides it. If your records are subpoenaed, your therapist should notify you so you can consult with an attorney. In many cases, a therapist or their legal counsel will challenge a subpoena to protect your privacy to the extent the law allows.

A mental health crisis is any situation in which a person's behavior, emotions, or thoughts put them at risk of harming themselves or others, or prevent them from being able to care for themselves or function in daily life. Examples include suicidal thoughts or actions, self-harm, psychotic episodes, severe panic attacks, and emotional distress so intense that the person cannot cope. A crisis requires immediate support — it is not something to wait out or manage alone.

The 988 Suicide and Crisis Lifeline is a free, confidential service available 24 hours a day, 7 days a week, across the United States. You can reach it by calling or texting 988. Trained counselors provide immediate support for people in suicidal crisis, emotional distress, or any mental health emergency. You do not need to be suicidal to call — the line is for anyone who is struggling and needs someone to talk to right now. Veterans can press 1 after dialing 988 to reach the Veterans Crisis Line.

Call or text 988 when you or someone you know is experiencing suicidal thoughts, emotional distress, or a mental health crisis and needs immediate support by phone. Go to the emergency room (or call 911) when there is an active suicide attempt, an overdose, severe self-injury requiring medical attention, or any situation involving immediate physical danger. If you are unsure, calling 988 first is a good step — the counselor can help you determine the level of care needed.

Take it seriously every time. Ask them directly and calmly whether they are thinking about killing themselves — research shows that asking does not increase risk. Listen without judgment, let them know you care, and do not leave them alone if the danger feels immediate. Help them contact the 988 Suicide and Crisis Lifeline (call or text 988) or take them to the nearest emergency room. Remove access to lethal means (such as firearms or medications) if you can do so safely. You do not have to handle this alone — reaching out for professional help is the right thing to do.

Suicidal thoughts are more common than many people realize — they can occur during periods of intense stress, depression, grief, or hopelessness. Having suicidal thoughts does not mean a person will act on them, but they should always be taken seriously. Suicidal thoughts exist on a spectrum, from passive thoughts ('I wish I weren't here') to active plans. Any level of suicidal thinking deserves professional support. If you or someone you know is experiencing these thoughts, contact the 988 Lifeline or a mental health professional. Learn more about [self-harm and related concerns](/conditions/self-harm).

A safety plan is a written, personalized document you create with a therapist or counselor that outlines specific steps to take when you are in crisis. It typically includes warning signs that a crisis may be developing, coping strategies you can use on your own, people you can contact for support, professional resources and crisis lines (like 988), and steps to make your environment safer. Having a plan in place before a crisis occurs makes it easier to act when you are in distress. Ask your therapist about creating one together.

The Crisis Text Line is a free, confidential text-based crisis service. To use it, text HOME to 741741 from anywhere in the United States. A trained crisis counselor will respond and help you work through what you are experiencing. Conversations happen entirely by text, which can be helpful for people who are not comfortable talking on the phone or who are in a situation where a phone call is not possible. The service is available 24/7.

Approach the conversation with care, not alarm. Let them know you have noticed and that you are concerned — avoid ultimatums, guilt, or expressing disgust. Do not try to force them to stop, as self-harm often serves as a coping mechanism and they need professional help to develop safer alternatives. Encourage them to talk to a therapist, and offer to help them find one. If they are in immediate danger, contact 988 or go to the emergency room. For more information, read about [self-harm and treatment options](/conditions/self-harm).

Yes. Emergency rooms are equipped to handle mental health emergencies, including suicidal crises, psychotic episodes, and severe emotional distress. If you go to the ER for a mental health concern, you will typically be assessed by a mental health professional who will determine the level of care you need — which may include stabilization, a referral to outpatient services, or inpatient psychiatric care. You do not need to have a physical injury to go to the ER for mental health reasons.

After a crisis, follow-up care is critical. The period immediately after a crisis — especially after a suicidal crisis or hospitalization — is a high-risk time. Follow-up typically includes connecting with an outpatient therapist, establishing or adjusting medication with a prescriber, building a safety plan, and scheduling regular check-ins. If you were hospitalized, your discharge plan should include specific next steps. Do not wait weeks to follow up — try to see a mental health professional within a few days of the crisis.

You cannot force someone to accept help, but you can continue to express your concern without pressure. Let them know you care, that help is available, and that you will be there when they are ready. If you believe they are in immediate danger, call 988 to get guidance from a crisis counselor on what to do, or call 911 if there is an active emergency. Taking care of your own mental health is also important — supporting someone in crisis is stressful, and organizations like NAMI offer support groups for families and loved ones.

DBT is a structured, evidence-based therapy originally developed by Marsha Linehan to treat Borderline Personality Disorder (BPD) and chronic suicidality. It combines cognitive behavioral techniques with mindfulness and acceptance strategies. The term 'dialectical' refers to balancing two things at once — accepting yourself as you are while also working to change. A comprehensive DBT program includes individual therapy, skills group, phone coaching, and a therapist consultation team.

While DBT was originally designed for BPD, it is now used effectively for a wide range of conditions including chronic suicidality, self-harm, eating disorders, substance use disorders, depression, anxiety, and PTSD. DBT is especially helpful for people who experience intense emotions, have difficulty with impulse control, or struggle with unstable relationships. It is available for adults, adolescents, and has been adapted for children.

CBT focuses primarily on identifying and changing unhelpful thought patterns and behaviors. DBT includes these cognitive behavioral elements but adds a strong emphasis on emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. DBT also places more emphasis on the therapeutic relationship and on validation — accepting the client's experience as understandable while encouraging change. DBT is typically more structured and intensive than standard CBT.

The four DBT skill modules are Mindfulness (learning to be present and aware without judgment), Distress Tolerance (surviving crisis moments without making things worse), Emotion Regulation (understanding and managing intense emotions), and Interpersonal Effectiveness (communicating needs and maintaining healthy relationships). Skills are taught in group sessions and practiced between sessions with coaching from your individual therapist.

A standard comprehensive DBT program lasts about one year, which includes cycling through all four skill modules twice. Some programs offer shorter courses, and some people continue beyond a year if needed. The skills group component typically meets weekly for about two hours, and individual therapy sessions are held weekly as well. The length of treatment reflects the fact that building and internalizing new skills takes sustained practice.

Individual DBT sessions focus on your personal goals, applying skills to specific situations in your life, processing difficult events, and addressing therapy-interfering behaviors. The skills group is more like a class — a trained facilitator teaches the four DBT skill modules to a group of participants, with practice exercises and homework. In a comprehensive DBT program, you attend both simultaneously because they serve complementary functions.

No. While DBT was developed for BPD, you do not need that diagnosis to benefit from it. DBT skills are helpful for anyone who struggles with emotional intensity, impulsive behavior, difficulty in relationships, or chronic feelings of emptiness. Many therapists offer DBT skills training or DBT-informed therapy for conditions like depression, anxiety, eating disorders, and substance use — with or without a BPD diagnosis.

Yes. DBT for adolescents (DBT-A) is a well-established adaptation that includes the same core skills with modifications for teens. One key difference is that DBT-A includes a family component — parents or caregivers attend the skills group alongside their teen and learn the same skills. This helps the entire family communicate more effectively and manage emotional situations together.

Comprehensive DBT programs can be more expensive than standard therapy because they involve multiple components — individual sessions, skills group, and phone coaching. Individual sessions typically cost $100 to $250 per session, and skills groups may range from $50 to $150 per session. Many insurance plans cover DBT, especially when it is deemed medically necessary. Check with your provider about coverage for both the individual and group components.

Yes. Many DBT programs now offer both individual sessions and skills groups online via video. Research during and after the pandemic has supported the effectiveness of telehealth DBT. Online delivery can make it easier to attend the multiple weekly commitments that comprehensive DBT requires. Some programs offer a hybrid model with in-person individual sessions and online skills groups, or vice versa.

DBT workbooks and self-help resources can be a useful supplement, but they are generally not a substitute for working with a trained therapist. A key part of DBT is having a therapist help you apply skills to real situations in your life, provide coaching during crises, and hold you accountable. That said, if a comprehensive DBT program is not available or affordable, a DBT skills workbook combined with individual therapy from a DBT-informed therapist can still be beneficial.

Cognitive Behavioral Therapy (CBT) and Behavioral Activation are the most well-researched treatments for depression. Interpersonal Therapy (IPT) is also highly effective, especially when depression is linked to relationship difficulties or life transitions. For chronic or recurring depression, therapies like Mindfulness-Based Cognitive Therapy (MBCT) can help prevent relapse. Your therapist will recommend an approach based on the nature and severity of your depression.

For mild-to-moderate depression, therapy alone is often effective. For moderate-to-severe depression, research shows that combining therapy with antidepressant medication tends to produce the best outcomes. Medication can help stabilize your mood enough to engage meaningfully in therapy. This decision should be made with your treatment providers based on your specific situation and preferences.

Many people begin to notice improvements within 4 to 8 sessions, though a full course of CBT for depression typically involves 12 to 20 sessions. The pace of progress varies depending on the severity and duration of your depression, whether you are also using medication, and how consistently you practice skills between sessions. Your therapist will track progress and adjust the treatment plan as needed.

Yes. Therapy is an important component of treatment for severe depression, though it is usually combined with medication in these cases. For people with severe symptoms, a therapist may start with small, manageable goals — such as simply getting out of bed and following a basic routine — before moving into deeper cognitive work. In some cases, a higher level of care such as an intensive outpatient program may be recommended.

Depression can recur, especially for people who have had multiple episodes. However, therapy significantly reduces the risk of relapse by teaching you to recognize early warning signs and respond to them effectively. Approaches like MBCT are specifically designed to prevent recurrence. Some people choose to continue periodic maintenance sessions after completing treatment as an added safeguard.

This is one of the cruelest aspects of depression — it robs you of the motivation to do the things that would help. Many therapists offer online sessions, which removes the barrier of leaving your house. It can also help to schedule sessions at a consistent time, ask a trusted person to help you keep the appointment, or start with the smallest possible step. Behavioral Activation, a core technique in depression treatment, is specifically designed to help with this exact problem.

Sadness is a normal emotional response to difficult events and typically passes as circumstances change. Depression is a persistent condition lasting at least two weeks that involves not just sadness but also loss of interest in activities, changes in sleep and appetite, difficulty concentrating, fatigue, and sometimes feelings of worthlessness or hopelessness. If low mood is affecting your ability to function or does not lift after a couple of weeks, it is worth talking to a professional.

With insurance, copays for therapy sessions typically range from $20 to $75. Without insurance, sessions generally cost $100 to $250 depending on your location and the therapist's credentials. Many therapists offer sliding scale fees based on income, and community mental health centers provide services at reduced rates. Some employers also offer free sessions through Employee Assistance Programs (EAPs).

Yes. Multiple research studies have found that online CBT is as effective as in-person therapy for treating depression. Online therapy also removes common barriers like transportation difficulties and the low energy that depression causes. The key factor is working with a licensed therapist using an evidence-based approach, regardless of whether sessions are in person or virtual.

If you are in immediate danger, call 911 or go to your nearest emergency room. For suicidal thoughts or emotional crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988 — trained counselors are available 24/7. The Crisis Text Line is also available by texting HOME to 741741. These services are free and confidential. Having suicidal thoughts does not mean you are beyond help — crisis support and therapy can make a real difference.

EMDR (Eye Movement Desensitization and Reprocessing) is a structured therapy that helps the brain reprocess traumatic memories so they no longer trigger intense emotional and physical reactions. During a session, your therapist guides you through recalling a distressing memory while simultaneously engaging in bilateral stimulation — typically side-to-side eye movements, but sometimes taps or tones. This process appears to help the brain integrate the memory in a way that reduces its emotional charge. Over time, the memory remains but no longer feels overwhelming or intrusive. EMDR was originally developed for PTSD but is now used for anxiety, phobias, grief, and other conditions. Learn more about its broader applications in our articles on [EMDR for depression](/blog/emdr-for-depression) and [EMDR for grief](/blog/emdr-for-grief).

No. EMDR and hypnosis are completely different approaches. During EMDR, you remain fully conscious, alert, and in control at all times. You are not put into a trance or suggestive state. The bilateral stimulation used in EMDR (such as eye movements) may look unusual, but it is a structured therapeutic technique, not a form of hypnosis. You can stop or pause the process at any point during a session.

No, and this is one of the reasons many people prefer EMDR over traditional talk therapy for trauma. You do not need to describe the traumatic event in extensive detail to your therapist. You will need to briefly identify the memory and the feelings and beliefs associated with it, but the reprocessing work happens internally. Your therapist guides the process without requiring you to narrate every detail of what happened. This makes EMDR a good option for people who find it too distressing to talk at length about their experiences.

The number of sessions varies depending on the complexity of your trauma history. For a single traumatic event in an otherwise stable life, many people see significant improvement in 6 to 12 sessions. Complex trauma — such as prolonged childhood abuse or multiple traumatic events — typically requires more sessions, sometimes 20 or more. Your therapist will conduct a thorough assessment and give you an estimated timeline, but the pace of treatment depends on how your brain responds to the reprocessing. If you want faster results, an intensive format may help — learn more in our [EMDR intensives guide](/blog/emdr-intensives-guide).

Yes. Many therapists now offer EMDR via telehealth, and research supports its effectiveness in a virtual format. Instead of following the therapist's finger with your eyes, you may follow a moving dot on the screen or use self-administered taps (called butterfly taps) for bilateral stimulation. Virtual EMDR works well for many people, though some therapists and clients prefer in-person sessions for more complex trauma work. Ask your provider about their experience delivering EMDR online before starting. For more details, see our article on [whether you can do EMDR online](/blog/can-you-do-emdr-online).

Yes. EMDR is one of the most well-researched therapies for PTSD and trauma. It is recommended by the World Health Organization (WHO), the American Psychological Association (APA), and the Department of Veterans Affairs as a frontline treatment for PTSD. Dozens of randomized controlled trials have demonstrated its effectiveness. It is considered as effective as trauma-focused CBT for PTSD, and some research suggests it may work faster for certain individuals. For a look at the data, see our article on [EMDR statistics and success rates](/blog/emdr-statistics-success-rates).

EMDR is generally well-tolerated, but some people experience temporary side effects during or after sessions. These can include vivid dreams, heightened emotions, light-headedness, or feeling emotionally drained after a session. Some people notice that new memories or feelings surface between sessions as the brain continues to process material. These effects are usually short-lived and are considered a normal part of the healing process. Your therapist will prepare you for this and teach you grounding techniques to manage any discomfort. For a detailed overview, see our article on [EMDR side effects](/blog/emdr-side-effects).

There is no credible evidence that EMDR creates false memories. EMDR does not involve suggestion, guided imagery, or leading questions — the reprocessing happens internally as your brain makes its own associations. That said, it is possible for any form of memory recall (whether in therapy or not) to involve some degree of reconstruction, since human memory is imperfect by nature. A well-trained EMDR therapist follows standardized protocols that minimize any risk of suggestion. If you have concerns, discuss them with your therapist before beginning treatment.

For most people, EMDR leads to significant improvement. However, it is normal to feel temporarily worse during the early stages of treatment as painful memories are activated and reprocessed. This is not a sign of failure — it is part of the healing process. In rare cases, people with certain conditions (such as dissociative disorders or active psychosis) may need additional stabilization before EMDR is appropriate. A qualified therapist will screen for these issues and ensure you have adequate coping skills before beginning reprocessing work.

Research suggests that the results of EMDR are durable and long-lasting. Once a traumatic memory has been fully reprocessed, the reduction in distress tends to hold over time. Follow-up studies have shown that treatment gains are maintained months and even years after completing EMDR. However, new life stressors or additional traumatic events may bring up new material that could benefit from additional sessions. Many people complete a course of EMDR and do not need to return, while others come back periodically for tune-ups.

EMDR session fees are generally comparable to standard therapy rates, which range from $100 to $250 per session depending on the provider's experience, location, and credentials. EMDR intensives — longer sessions or multi-day formats — can cost significantly more, sometimes $1,000 to $3,000 or more for a concentrated block of treatment. Some therapists charge a premium for EMDR due to the specialized training required. Ask about fees upfront and whether the provider offers sliding scale options.

In most cases, yes. EMDR is a recognized, evidence-based treatment, and most insurance plans cover it the same way they cover other forms of psychotherapy. Your therapist will typically bill it under standard psychotherapy codes. However, coverage depends on your specific plan, your deductible, and whether the therapist is in-network. EMDR intensives (extended sessions) may not always be covered at the same rate. Contact your insurance provider and ask specifically about coverage for EMDR before starting treatment.

An EMDR intensive is a concentrated format of EMDR therapy where you complete multiple hours of treatment in a single day or over a few consecutive days, rather than spreading sessions out over weeks or months. A typical intensive might involve three to six hours of EMDR in one day. This format can accelerate progress significantly and is particularly appealing for people who want faster results, have limited availability for weekly sessions, or are traveling to see a specialist. Intensives are not appropriate for everyone, so your therapist will assess whether this format is a good fit for your situation.

The best starting point is the EMDR International Association (EMDRIA) therapist directory, which lists clinicians who have completed approved EMDR training. Look for therapists who are EMDRIA-certified or EMDRIA-approved consultants, as this indicates a higher level of training and supervised experience. You can also ask a prospective therapist how many hours of EMDR-specific training they have completed and how many clients they have treated with EMDR. A qualified EMDR therapist should have completed at least the basic EMDRIA-approved training program, which includes both didactic instruction and supervised practice.

Ask about their EMDR training and certification level — specifically whether they completed an EMDRIA-approved training and whether they are EMDRIA-certified. Ask how many clients they have treated with EMDR and whether they have experience with your specific concern (such as PTSD, anxiety, or grief). Find out how they structure treatment, including how many preparation sessions to expect before reprocessing begins. Ask about their approach if you become highly distressed during a session and what resources they provide between sessions. Finally, clarify logistics like session length, frequency, cost, and insurance coverage.

ART (Accelerated Resolution Therapy) is a newer, evidence-based therapy that, like EMDR, uses bilateral eye movements to help reprocess traumatic memories. The key difference is that ART follows a more directive, structured protocol and often produces results in fewer sessions — sometimes as few as one to five. ART also uses a technique called Voluntary Image Replacement, where you actively replace the distressing images associated with a memory with new, more positive ones. Unlike EMDR, ART does not require you to report the details of your trauma to the therapist at all. Both therapies are effective for trauma, but they differ in pacing, technique, and how much the client needs to verbally share.

Yes. ART is a recognized, evidence-based therapy with a growing body of research supporting its effectiveness. Multiple randomized controlled trials have shown significant reductions in PTSD symptoms, depression, and anxiety following ART treatment. It has been studied in military veterans, first responders, and civilian populations. While it does not yet have the same volume of research as EMDR or CBT (which have been studied for decades longer), the existing evidence is strong and promising. ART is approved by SAMHSA's National Registry of Evidence-Based Programs and Practices.

One of the most notable aspects of ART is its brevity. Many people experience significant relief in just one to five sessions, even for long-standing trauma. Each session typically lasts 60 to 90 minutes. The number of sessions depends on how many traumatic memories need to be addressed and the overall complexity of your history. For a single traumatic event, one or two sessions may be sufficient. For multiple traumas or complex presentations, more sessions will be needed, though the total is still often fewer than with other trauma therapies.

Yes, ART can be delivered via telehealth. The eye movement component is adapted for a virtual setting — you follow the therapist's hand or a visual cue on the screen. Research on virtual ART is still emerging, but early evidence and clinical experience suggest it can be effective online. As with EMDR, some therapists prefer in-person sessions for more complex cases. If you are considering virtual ART, ask the therapist about their experience providing it in an online format and whether they believe it is appropriate for your situation.

Neither is universally better — they are different approaches with strong evidence for different concerns. EMDR and trauma-focused CBT are both recommended as first-line treatments for PTSD, and research shows comparable outcomes for most people. EMDR may be preferred by people who find it difficult to talk extensively about their trauma, since it requires less verbal narration. CBT may be preferred for people who benefit from structured homework, skill-building, and cognitive restructuring. Some people try one and switch to the other if it is not the right fit. The best therapy is the one that works for you with a therapist you trust.

Yes, and many people do. It is common to combine EMDR with talk therapy, CBT, or DBT skills training, especially for complex presentations. For example, a person with PTSD and emotional dysregulation might use EMDR to reprocess traumatic memories while also learning DBT skills to manage intense emotions between sessions. Your therapists should be aware of each other and coordinate care to avoid conflicting approaches. Some therapists are trained in multiple modalities and can integrate EMDR into a broader treatment plan within the same sessions.

Both EMDR and medication (particularly SSRIs like sertraline and paroxetine) are effective treatments for PTSD, and the best choice depends on your preferences, symptom severity, and overall health. Research suggests that EMDR and trauma-focused therapy may produce more lasting results than medication alone, since therapy addresses the root cause rather than just managing symptoms. However, medication can be very helpful for stabilizing symptoms enough to engage in therapy, and some people benefit from using both simultaneously. A psychiatrist or prescribing provider can help you weigh the options based on your individual situation.

An evidence-based therapy is one that has been tested in randomized controlled trials (RCTs) and shown to produce meaningful improvements for specific conditions. The results are published in peer-reviewed journals so other researchers can verify them. It means we have strong scientific evidence that the approach works, not just clinical opinion.

No. Some effective approaches lack formal research because conducting clinical trials is expensive, some therapies are difficult to study with standard methods, and newer approaches simply have not had time to accumulate a large body of evidence. The absence of research is not the same as evidence of ineffectiveness.

A randomized controlled trial (RCT) randomly assigns participants to either a treatment group or a control group. This design reduces bias and helps researchers determine whether the therapy itself — rather than other factors — is responsible for the improvement. RCTs are considered the gold standard for evaluating treatment effectiveness.

Ask them directly. Inquire about the specific approach they use, whether it has research support for your concerns, and what training they have received in that approach. Also ask how they measure progress during treatment. A good therapist will welcome these questions and answer them transparently.

Evidence-based therapy (EBT) follows structured protocols that have been tested and validated in RCTs for specific conditions. Evidence-informed therapy draws on research findings more flexibly, adapting techniques to the individual client rather than following a strict manual. Both incorporate scientific knowledge, but EBT adheres more closely to tested procedures.

Not necessarily. A newer therapy simply means it has been developed more recently, which often means it has less research behind it. Established therapies like CBT have decades of validation across many conditions and populations. Newer approaches may prove equally effective over time, but longevity of research is a meaningful advantage.

Yes. ClinicalTrials.gov lists active studies that are recruiting participants across the country. Participation is voluntary and requires informed consent. Each trial has specific eligibility criteria, and you can search by condition, location, and treatment type to find studies that may be a fit.

Research requires significant funding and institutional support. CBT, for example, has over 50 years of study backed by major universities and research grants. Newer or less mainstream approaches may have promising results but fewer published studies simply because they have not had the same resources or time to build an equivalent evidence base.

Not exclusively, but insurers generally prefer research-supported approaches. Therapies with strong evidence are more likely to be approved for coverage and less likely to face pushback during utilization reviews. Coverage varies by plan, so check with your insurer about which approaches are covered under your specific policy.

Look for peer-reviewed research supporting the specific claims being made. Be wary of guaranteed results, testimonials as the sole evidence, or language that sounds too good to be true. Verify the practitioner's credentials and check whether the approach appears in reputable databases like APA Division 12 or the Cochrane Library.

APA Division 12 is the Society of Clinical Psychology within the American Psychological Association. It maintains a publicly accessible list of psychological treatments that have been evaluated based on the strength of their research support. It is one of the most credible starting points for understanding which therapies have the strongest evidence for specific conditions.

Several reputable sources provide accessible summaries of therapy research: APA Division 12 for researched treatments, the Cochrane Library for systematic reviews, SAMHSA's Evidence-Based Practices Resource Center, NICE guidelines from the UK, and PubMed for searching the primary scientific literature directly.

Publication bias means that studies with positive results are more likely to be published than those with negative or inconclusive findings. This can make a therapy appear more effective than it actually is because the full picture is hidden. Cochrane systematic reviews help address this by actively searching for unpublished data. When evaluating evidence, look for meta-analyses rather than relying on a single positive study.

Efficacy refers to how well a therapy works in controlled research settings, such as randomized controlled trials. Effectiveness refers to how well it works in the real world, where clients often have multiple diagnoses, varying motivation, and less-than-ideal conditions. A therapy can have strong efficacy but somewhat lower effectiveness, which is normal. Both matter when evaluating a treatment.

Conflicting findings are a normal part of science, not a sign that research is unreliable. Different studies use different methods, populations, and outcome measures. Rather than focusing on any single study, look for meta-analyses or systematic reviews that synthesize findings across many studies. These give a more balanced and reliable picture than individual trials.

Start by checking your insurance provider's directory for in-network therapists, or use online directories like Psychology Today, Therapy Den, or the Inclusive Therapists directory. You can filter by location, specialty, insurance accepted, and other preferences. Asking your primary care doctor, friends, or family for referrals is also effective. Once you have a few names, schedule brief phone consultations (most therapists offer these for free) to see who feels like a good fit.

Look for a therapist who is licensed in your state. Common licensed titles include Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), and Licensed Psychologist (PhD or PsyD). Each of these requires a graduate degree, supervised clinical hours, and passing a licensing exam. If you have a specific concern — such as trauma, OCD, or an eating disorder — look for someone with specialized training or certification in that area.

A therapist is a broad term for any licensed professional who provides talk therapy, including social workers, counselors, and psychologists. A psychologist holds a doctoral degree and specializes in psychological assessment and therapy but typically cannot prescribe medication. A psychiatrist is a medical doctor who specializes in mental health and can prescribe medication; many psychiatrists focus on medication management rather than talk therapy. For a more detailed comparison, see our guide on [therapist vs. psychologist vs. psychiatrist](/blog/therapist-vs-psychologist-vs-psychiatrist).

A consultation call is a brief (usually 10 to 20 minute) phone conversation with a potential therapist before you commit to scheduling a full session. Most therapists offer these for free. Use the call to ask about their experience with your specific concerns, their approach to therapy, practical details like fees and availability, and to get a sense of whether you feel comfortable talking to them. It is one of the best ways to find the right fit.

Red flags include a therapist who talks about themselves excessively, dismisses or minimizes your feelings, pushes you to move faster than you are ready, breaks confidentiality without cause, has poor boundaries (such as contacting you outside of sessions for personal reasons), or makes you feel judged. A therapist who never checks in on your progress or avoids discussing a treatment plan may also not be the right fit. For a fuller list, read our article on [signs of a bad therapist](/blog/signs-of-bad-therapist).

Good signs include feeling heard and respected, a therapist who asks thoughtful questions and listens more than they talk, transparency about their approach and what to expect, willingness to discuss your goals and track progress, and comfort with being questioned or challenged by you. You should feel safe enough to be honest, even about difficult topics. A strong therapeutic relationship — where you feel trust and collaboration — is one of the best predictors of positive outcomes.

Absolutely. The therapeutic relationship is the single most important factor in therapy outcomes, and not every therapist will be the right match. If after a few sessions you do not feel comfortable, connected, or confident in your therapist's approach, it is completely okay to find someone else. You do not owe an explanation, though sharing your reasons can be helpful. A good therapist will not take it personally and may even help you find a better fit.

In many cases, yes. Therapists with specialized training tend to use more targeted, evidence-based techniques for specific conditions. This is especially true for issues like OCD (look for ERP training), trauma/PTSD (look for EMDR or CPT certification), eating disorders, and substance use disorders. For more general concerns like stress, relationship difficulties, or life transitions, a generalist therapist with solid clinical skills can be an excellent choice.

Psychology Today's directory is the largest and most widely used — it allows filtering by insurance, specialty, location, and more. Other helpful directories include Therapy Den (which emphasizes inclusivity and social justice), Inclusive Therapists (focused on marginalized communities), the SAMHSA treatment locator, Open Path Collective (for affordable therapy), and your insurance company's own provider directory. Many professional organizations, such as the AAMFT and ADAA, also maintain therapist finders specific to their specialty.

This is a personal preference, and there is no single right answer. Some people feel more comfortable and understood working with a therapist who shares their cultural background, race, gender identity, sexual orientation, or life experience. Others prioritize clinical expertise above shared identity. What matters most is that your therapist is culturally competent — meaning they understand and respect your experiences, even if their background differs from yours. If this is important to you, bring it up during your consultation call.

No. You do not need to arrive with a preference for CBT, EMDR, DBT, or any other approach. A good therapist will assess your needs during the first few sessions and recommend the approach that best fits your situation. That said, doing some research can help you ask better questions during consultations. If a therapist can only offer one approach regardless of the problem, that may be a limitation worth noting.

Therapist shortages are common, especially for specialists. Contact three to five therapists at once rather than waiting to hear back from one at a time. Ask to be placed on cancellation lists for earlier openings. Consider telehealth — therapists in other parts of your state or in states participating in interstate compacts like PSYPACT may have sooner availability. In the meantime, your employer's EAP can often provide a few free sessions within days, and crisis resources like the 988 Suicide and Crisis Lifeline are always available.

Wait times vary significantly by area, specialty, and insurance status. For a general therapist accepting your insurance, expect one to four weeks in most metro areas. For specialists (OCD, eating disorders, trauma), wait times of four to eight weeks are not uncommon. Private-pay therapists and online platforms often have shorter wait times. If urgency is a factor, mention it when you call — many therapists prioritize clients with acute needs.

Every state maintains a public database where you can search for a therapist by name and confirm their license status, including whether there are any disciplinary actions on record. Search for your state's licensing board website (for example, Maryland Board of Professional Counselors, or Virginia Board of Counseling). You can also ask the therapist directly for their license number during the consultation call. Verification takes less than five minutes and is always worth doing.

A therapist is a general term for any licensed mental health professional who provides talk therapy. A psychologist holds a doctoral degree (PhD or PsyD) and specializes in psychological assessment and therapy. A psychiatrist is a medical doctor (MD) who can prescribe medication and may also provide therapy. All three can help with mental health conditions, but their training and scope of practice differ.

The length of therapy varies depending on your goals and the complexity of the issues. Short-term therapy (such as CBT for a specific phobia) may take 8 to 12 sessions. More complex issues or longer-term personal growth work may continue for several months or longer. Your therapist will discuss a treatment plan with you early on.

Yes. Therapists are bound by strict confidentiality laws and professional ethics. What you share in therapy stays between you and your therapist, with very few exceptions — primarily when there is an imminent risk of harm to yourself or others, or when required by law (such as suspected child abuse).

Progress in therapy often looks like gradual improvements in mood, coping skills, relationships, and overall functioning. You may find yourself handling stressful situations better, feeling more self-aware, or experiencing fewer symptoms. Your therapist will check in on your progress regularly and adjust the approach if needed.

Absolutely. The therapeutic relationship is one of the most important factors in successful therapy. If you do not feel comfortable or connected with your therapist after a few sessions, it is perfectly okay to find someone else. A good therapist will not take it personally and may even help you find a better match.

In most cases, no. You can typically contact a therapist directly and schedule an appointment. However, some insurance plans (particularly HMOs) may require a referral from your primary care doctor. Check your insurance plan's requirements to be sure.

You can talk about anything that is on your mind — current stressors, relationships, past experiences, emotions you are struggling with, or goals you want to achieve. There is no wrong topic. Your therapist will help guide the conversation and may ask questions to explore things more deeply.

Research shows that online therapy (also called teletherapy) is as effective as in-person therapy for many conditions, including anxiety and depression. It offers the added benefits of convenience and accessibility. However, some people prefer the in-person experience, and certain conditions may benefit more from face-to-face treatment.

No. You are never forced to share in group therapy. Therapists do not pressure members to speak before they are ready, and most groups have explicit norms that participation is voluntary. Many people spend the first few sessions mostly listening, and that is perfectly fine. Over time, most members naturally become more comfortable and begin to share at their own pace. A good group therapist will create a safe environment where you feel invited — not pressured — to participate.

Yes. A large body of research supports group therapy's effectiveness. A meta-analysis of 329 randomized controlled trials involving more than 27,000 patients found that group therapy produces outcomes equivalent to individual therapy for a wide range of conditions, including depression, anxiety, and substance use disorders (American Psychological Association). For some issues — such as social anxiety, grief, and interpersonal difficulties — group therapy may even offer unique advantages because it provides real-time practice with social interaction and feedback from peers.

This is a common concern, especially in smaller communities. Most group therapists screen members before the group begins to minimize the chance of conflicts of interest or dual relationships. If you do encounter someone you know, the group's confidentiality agreement means neither of you should acknowledge each other's participation outside the group. If this situation would cause significant discomfort, raise it with the therapist beforehand — they can help you find a group where this is less likely, or discuss how to handle it if it does happen.

Yes, and many people do. Combining group and individual therapy can be especially effective — individual sessions allow you to process personal material in depth, while group sessions provide support, perspective, and opportunities to practice new skills with others. Some treatment approaches actually require both: [dialectical behavior therapy (DBT)](/blog/dbt-skills-explained), for example, includes weekly individual therapy alongside a skills training group. Talk to your therapist about whether adding group therapy could complement your current treatment.

Group therapists are bound by the same confidentiality laws and professional ethics as individual therapists — they cannot disclose your participation or anything you share. Group members also agree to confidentiality norms at the start of treatment, meaning they commit to not sharing what is discussed outside the group. However, other group members are not legally bound by HIPAA in the way a licensed therapist is. While breaches are rare, this is an important distinction to understand. If confidentiality is a major concern, discuss it with the group therapist before joining. For more on [how therapy confidentiality works](/faq), see our confidentiality FAQ.

Crying in group therapy is completely normal and happens regularly. Groups are intentionally designed to be supportive, nonjudgmental spaces where emotions are welcomed — not avoided. Other members will likely respond with empathy, and many will have cried in the group themselves. Therapists are skilled at holding space for strong emotions and will make sure you feel safe. If anything, showing vulnerability often deepens trust within the group and can be a meaningful moment for everyone present.

Most therapy groups have between 5 and 12 members and are led by one or two therapists. This size is intentional — it is large enough to offer diverse perspectives and interpersonal dynamics, but small enough that each member has time to participate and feel seen. Some specialized groups (such as [DBT skills groups](/blog/dbt-skills-group-what-to-expect)) may have slightly different structures, but the 5-to-12 range is standard across most group therapy formats.

Most insurance plans cover group therapy, just as they cover individual therapy. Group therapy sessions are billed using specific CPT codes (typically 90853 for group psychotherapy). Your copay for group therapy may be the same as or lower than your individual therapy copay, depending on your plan. Before joining a group, call your insurance company and ask whether group psychotherapy is covered, what your copay or coinsurance would be, and whether the group therapist is in-network. For more on navigating insurance, see our [insurance and cost FAQ](/faq).

It is normal to feel anxious before and during your first few group sessions — you are sharing a space with strangers and talking about personal topics, so some nervousness is expected. For most people, this initial anxiety decreases significantly within the first few weeks as they become more comfortable with the group. In fact, for people with [social anxiety](/blog/person-centered-therapy-for-anxiety), group therapy can be particularly beneficial because it provides a safe, structured environment to practice being around others. If your anxiety feels unmanageable, talk to the group therapist — they can offer strategies to help you ease in.

There is no severity threshold for group therapy. Groups serve people across a wide range of experiences — from those managing diagnosed conditions to those dealing with everyday stress, life transitions, or loneliness. Many group members describe feeling unsure about whether they 'belong' at first, and then discovering that the group is exactly what they needed. If something is affecting your quality of life, you deserve support. A group therapist can help you determine whether a particular group is a good match for where you are right now.

This depends on the type of group. Individual sessions typically run 60 to 90 minutes, with some groups (particularly skills-based groups) lasting up to 120 minutes. In terms of total duration, structured groups — such as [CBT-based groups](/blog/cbt-techniques-you-can-try) or DBT skills groups — usually run for a set number of weeks, often 8 to 16. Process-oriented groups, which focus on interpersonal dynamics and self-awareness, may be open-ended and continue for months or even years. Your group therapist will explain the format and expected duration before you begin.

The key difference is who leads the group and what the goals are. Group therapy is led by a licensed therapist who uses evidence-based techniques to facilitate therapeutic change — it involves clinical assessment, treatment goals, and structured interventions. A support group is typically peer-led (or led by a trained facilitator who may not be a licensed therapist) and focuses on shared experience, mutual encouragement, and coping. Both can be valuable, but group therapy offers the clinical structure and professional guidance needed for deeper psychological work. Some people benefit from participating in both.

Feeling like an outsider in the first few sessions is common and does not necessarily mean the group is wrong for you. It takes time to build trust and find your place. Most group therapists recommend giving it at least three to four sessions before deciding. That said, if you consistently feel uncomfortable, judged, or disconnected after giving it a fair chance, it is okay to discuss your concerns with the therapist. They can help you understand whether the dynamic will shift or whether a different group might be a better fit. Not every group works for every person, and finding the right one is part of the process.

Group therapy is generally more affordable than individual therapy. Without insurance, group sessions typically cost between $40 and $80 per session, which is roughly 30 to 50 percent of the cost of individual therapy. With insurance, your copay may be similar to or lower than your individual therapy copay. Some community mental health centers and training clinics offer group therapy at even lower rates. If cost is a concern, ask potential group therapists about sliding scale options, and check whether your insurance covers group psychotherapy (CPT code 90853). For more on [therapy costs and affordability](/blog/how-much-does-therapy-cost), see our detailed guide.

Most health insurance plans cover mental health services, including therapy. Under the [Mental Health Parity and Addiction Equity Act](/blog/does-insurance-cover-therapy), insurers are required to cover mental health treatment at the same level as medical treatment. However, coverage details vary — you may need to use an in-network provider, obtain pre-authorization, or meet a deductible first. Contact your insurance company to verify your specific benefits before scheduling. If you are considering a treatment center, see our article on [whether insurance covers treatment centers](/blog/does-insurance-cover-treatment-centers).

The cost of therapy without insurance typically ranges from $100 to $250 per session, depending on the therapist's credentials, location, and specialty. In major metropolitan areas, rates can be higher. Some therapists charge more for initial intake sessions, which tend to be longer. For a detailed breakdown of costs and ways to reduce them, see our guide on [how much therapy costs](/blog/how-much-does-therapy-cost).

A copay is the fixed amount you pay out of pocket each time you attend a therapy session when using insurance. Copays for mental health visits typically range from $20 to $60, depending on your plan. Your copay amount may differ based on whether you see an in-network or out-of-network provider. You can find your copay amount on your insurance card or by calling your insurer's member services line.

Out-of-network means the therapist does not have a contract with your insurance company. Some insurance plans offer out-of-network benefits, which means they will reimburse a portion of the cost after you meet a separate (usually higher) deductible. The reimbursement rate is often 50 to 80 percent of the allowed amount. If your plan has no out-of-network benefits, you would pay the full fee yourself. Always check your plan details before assuming coverage.

A superbill is a detailed receipt your therapist provides that includes diagnosis codes, procedure codes, session dates, and fees — everything your insurance company needs to process an out-of-network claim. You submit the superbill to your insurer (usually by uploading it to their portal or mailing it), and they reimburse you directly based on your out-of-network benefits. Ask your therapist if they provide superbills before your first session.

Yes. Therapy sessions with a licensed mental health provider are considered a qualified medical expense under both Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). You can use these funds to pay copays, deductibles, or the full cost of sessions. Keep your receipts for tax purposes, and check with your plan administrator if you have questions about eligible expenses.

Sliding scale means a therapist adjusts their fee based on your income and ability to pay. The reduced rate can be significantly lower than the standard fee — sometimes $40 to $80 per session. Not all therapists offer sliding scale spots, and availability may be limited. When calling a potential therapist, ask directly whether they offer sliding scale and what documentation (such as a recent pay stub) they may need.

An EAP is a benefit offered by many employers that provides free, short-term counseling — typically 3 to 8 sessions per issue. EAP services are confidential; your employer will not know you used the program. EAPs can be a good way to start therapy at no cost, and the counselor can help you transition to ongoing care if you need more sessions. Check with your HR department or benefits portal to see if your employer offers an EAP.

Yes, several options exist. Community mental health centers provide services on a sliding scale or at no cost. Graduate training clinics at universities offer therapy with supervised student therapists at reduced rates. Organizations like Open Path Collective connect people with therapists who charge $30 to $80 per session. The SAMHSA helpline (1-800-662-4357) can also help you locate free or low-cost services in your area. Learn more about [therapy costs and affordable options](/blog/how-much-does-therapy-cost).

Mental health parity is a federal requirement under the Mental Health Parity and Addiction Equity Act that says insurance companies must cover mental health and substance use treatment at the same level as medical and surgical care. This means your copays, deductibles, visit limits, and prior authorization requirements for therapy cannot be more restrictive than those for physical health services. If you believe your plan is violating parity, you can file a complaint with your state insurance commissioner.

Call the member services number on the back of your insurance card and ask specific questions: Is therapy covered? Do I need pre-authorization? What is my copay for in-network mental health visits? Do I have out-of-network benefits? Is there a session limit? What is my deductible, and has it been met? Taking notes during this call will help you avoid surprises. You can also check your plan's summary of benefits document, which is usually available online through your insurer's portal.

Most insurance plans now cover telehealth therapy sessions at the same rate as in-person visits. This became widespread during the COVID-19 pandemic, and most states have passed laws requiring continued telehealth coverage. However, coverage may depend on the platform used and whether the therapist is in-network. Verify with your insurer that teletherapy is covered under your plan before starting, and confirm that your therapist's telehealth setup meets your plan's requirements. For more on telehealth, see our [online vs. in-person therapy cost comparison](/blog/online-vs-in-person-therapy-cost).

Yes. Therapists with 15 or more years of experience typically charge 30 to 45 percent more than newly licensed providers. A newly licensed LCSW might charge $120 per session, while one with 15+ years of experience might charge $160 to $190. However, with in-network insurance, your copay is usually the same regardless of your therapist's experience level. For a full breakdown, see our guide on [therapy cost by therapist type](/blog/therapy-cost-by-therapist-type).

Generally yes. Online therapy through private practice telehealth is often 10 to 20 percent less than in-person sessions because therapists have lower overhead. Subscription platforms like BetterHelp and Talkspace range from $65 to $120 per week. However, private practice telehealth with a dedicated therapist typically offers better continuity of care. For a detailed comparison, see our [online vs. in-person therapy cost guide](/blog/online-vs-in-person-therapy-cost).

Many insurance plans now cover couples therapy when it is billed under a recognized mental health diagnosis. If one or both partners have a diagnosable condition such as anxiety, depression, or an adjustment disorder, and the couples work is part of the treatment plan, insurance may cover part or all of the cost. Ask your therapist about billing under CPT code 90847 (family therapy with patient present). Coverage varies by plan, so verify with your insurer before starting.

The DC metro area has some of the highest therapy costs in the country. In DC proper, expect to pay $225 to $300 per session for private pay. In nearby Maryland suburbs like Bethesda, rates typically range from $200 to $275. Northern Virginia (Arlington, Alexandria) is similar at $200 to $275. With in-network insurance, copays are usually $20 to $60 regardless of location. For a complete breakdown, see our [DMV therapy cost guide](/guides/therapy-cost-dc-maryland-virginia).

It depends on the type of program. Intensive outpatient programs (IOPs) are frequently covered by insurance as a higher level of care, with copays or coinsurance applying to each session day. Private therapy intensives and retreats (such as EMDR intensives or couples therapy retreats) are rarely covered directly, though individual sessions within an intensive may be billable under standard psychotherapy codes. Always verify coverage with your insurer before enrolling. Learn more in our [intensive therapy cost guide](/blog/intensive-therapy-cost-guide). For treatment center-specific costs, see our article on [mental health treatment cost by level of care](/blog/mental-health-treatment-cost-by-level).

Affirming therapy means the therapist recognizes and respects your sexual orientation and gender identity as natural aspects of who you are — not as problems to be fixed. An affirming therapist understands the unique stressors LGBTQ+ individuals face, including discrimination, family rejection, and internalized stigma, and incorporates that understanding into treatment. Affirming therapy is not a separate type of therapy but rather an approach that can be applied within any evidence-based treatment modality.

Look for therapists who explicitly state they are LGBTQ+ affirming in their profiles and have specific training or experience with LGBTQ+ clients. Directories like Psychology Today allow you to filter by specialization in LGBTQ+ issues. During an initial consultation, ask how they approach working with LGBTQ+ clients and what training they have received. Trust your instincts — you should feel safe and understood from the first conversation.

Conversion therapy — any practice aimed at changing a person's sexual orientation or gender identity — has been banned for minors in many U.S. states and several countries, but it remains legal for adults in most places. Every major medical and mental health organization has condemned conversion therapy as harmful and ineffective. If a therapist suggests your orientation or identity is something to be corrected, leave immediately and report them to their licensing board.

Gender identity therapy helps individuals explore and understand their gender identity in a supportive, nonjudgmental environment. It may involve processing feelings about gender, exploring options for social or medical transition, coping with dysphoria, and navigating relationships and societal reactions. A gender-affirming therapist does not push any particular outcome — they support you in understanding and living authentically as yourself.

Yes. Therapy can be a valuable space for exploring your identity, processing fears about how others will react, developing a plan for coming out, and coping with the emotional aftermath — whether responses are supportive or not. A therapist can help you decide when, how, and to whom you want to come out, while respecting that the timeline is entirely yours.

Yes, as long as the therapist has genuine training in LGBTQ+ affirming care, understands minority stress, and does not require you to educate them about basic LGBTQ+ concepts during your sessions. A therapist does not need to share your identity to be effective, but they do need to have done the work to be knowledgeable and culturally competent. That said, some clients prefer a therapist who shares their identity, and that preference is completely valid.

Yes. Many therapists specialize in working with LGBTQ+ youth and are trained to address issues like coming out, bullying, family conflict, gender dysphoria, and identity development. Affirming therapy for teens is especially important because LGBTQ+ youth face disproportionately high rates of anxiety, depression, and suicidal ideation. Parents and caregivers can also benefit from therapy or support groups to help them support their child.

Absolutely. Evidence-based approaches like the Gottman Method and Emotionally Focused Therapy (EFT) are effective for couples of all orientations. The key is finding a therapist who is affirming and experienced with same-sex relationship dynamics, which can include unique stressors like navigating societal stigma, differing levels of outness, and family-of-origin issues related to sexual orientation.

Yes. Family therapy can help when a family member's coming out creates tension, confusion, or conflict within the family. A skilled therapist helps family members process their own reactions while learning to provide support. Research shows that family acceptance is one of the strongest protective factors for LGBTQ+ youth mental health, making family therapy a valuable investment.

Minority stress refers to the chronic stress that LGBTQ+ individuals experience from living in a society that stigmatizes their identity — including discrimination, microaggressions, rejection, and the need to constantly assess whether environments are safe. Therapy helps by validating these experiences, building resilience, processing internalized stigma, and developing coping strategies. Understanding minority stress is a key competency of any truly affirming therapist.

Therapy and medication work through different mechanisms. Therapy involves working with a trained professional to understand and change patterns in your thoughts, emotions, and behaviors — it addresses the root causes and builds lasting coping skills. Medication alters brain chemistry to reduce symptoms like persistent sadness, excessive anxiety, or intrusive thoughts. Both are effective treatments, and for many conditions, research shows they work best when used together. The right approach depends on your specific diagnosis, severity, and personal preferences.

In most states, therapists (including licensed clinical social workers, licensed professional counselors, and marriage and family therapists) cannot prescribe medication. Psychologists generally cannot prescribe either, though a small number of states (including Louisiana, New Mexico, Illinois, Iowa, and Idaho) have granted prescribing privileges to specially trained psychologists. Medication is typically prescribed by psychiatrists, psychiatric nurse practitioners, or your primary care physician. For a detailed breakdown of provider types, see our guide on [therapist vs. psychologist vs. psychiatrist](/blog/therapist-vs-psychologist-vs-psychiatrist).

Medication is often recommended when symptoms are severe enough to interfere significantly with daily functioning — for example, when depression makes it hard to get out of bed, when anxiety is causing debilitating panic attacks, or when intrusive thoughts from OCD consume hours of the day. It may also be recommended when therapy alone is not producing sufficient improvement, or when a condition has a strong biological component (such as bipolar disorder or schizophrenia). A psychiatrist or prescribing provider can help you evaluate whether medication is appropriate for your situation.

For mild to moderate anxiety and depression, many clinical guidelines recommend starting with therapy — particularly evidence-based approaches like CBT — before adding medication. Therapy provides skills that last after treatment ends, while medication benefits typically last only as long as you take it. However, for severe symptoms, starting both simultaneously may be the most effective approach, as medication can reduce symptoms enough for you to engage meaningfully in therapy. There is no single right answer — the decision should be made collaboratively with your treatment providers.

They complement each other in important ways. Medication can reduce the intensity of symptoms — such as leveling out severe depression or calming chronic anxiety — so that you can engage more fully in the therapeutic process. Therapy, in turn, helps you develop coping strategies, address underlying issues, and make behavioral changes that medication alone does not provide. Research on conditions like depression, anxiety, OCD, and PTSD consistently shows that the combination of both treatments produces better outcomes than either one alone.

Psychiatrists (MDs or DOs specializing in mental health) and psychiatric nurse practitioners (PMHNPs) are the most qualified prescribers for psychiatric medication. Primary care physicians can also prescribe common psychiatric medications but may have less specialized knowledge. To get started, ask your therapist for a referral to a prescriber, contact your insurance company for a list of in-network psychiatrists, or ask your primary care doctor. The initial psychiatric evaluation typically takes 45 to 90 minutes and involves a thorough review of your symptoms, history, and treatment goals. Learn more about the differences in our article on [therapist vs. psychologist vs. psychiatrist](/blog/therapist-vs-psychologist-vs-psychiatrist).

Side effects vary depending on the medication type. SSRIs and SNRIs (common antidepressants) may cause nausea, headache, sleep changes, sexual dysfunction, or weight changes — most of these effects are mild and often improve within the first few weeks. Anti-anxiety medications like benzodiazepines can cause drowsiness and carry a risk of dependence. Mood stabilizers and antipsychotics have their own specific side effect profiles. Your prescriber should discuss potential side effects before you start any medication, and you should report any concerning effects promptly so adjustments can be made.

Do not stop medication abruptly without consulting your prescriber. Feeling better is often a sign the medication is working, not that you no longer need it. Stopping suddenly can cause withdrawal symptoms (sometimes called discontinuation syndrome) and a return of the original symptoms. When the time is right, your prescriber will help you taper off gradually and safely. For conditions like depression, guidelines often recommend staying on medication for at least 6 to 12 months after symptoms resolve to reduce the risk of relapse.

Several evidence-based strategies can support mental health without medication. Regular exercise has been shown to have significant antidepressant and anti-anxiety effects. Mindfulness and meditation practices reduce stress and improve emotional regulation. Adequate sleep, a balanced diet, and social connection all play important roles. Supplements like omega-3 fatty acids and vitamin D have some supporting evidence, though they are not substitutes for proven treatments. These strategies work best as complements to therapy, not replacements for professional care when it is needed.

Absolutely. The decision to take medication is yours. A good treatment provider will present options, explain the evidence, and respect your preferences. For many conditions, therapy alone is an effective treatment — especially for mild to moderate anxiety and depression. If you decline medication, be open with your therapist about it so you can work together on maximizing the effectiveness of your therapeutic approach. If your condition worsens or is not responding to therapy alone, it may be worth revisiting the conversation about medication as a tool rather than a failure.

Not necessarily. Many people take psychiatric medication for a defined period — often 6 months to 2 years — and then discontinue with their prescriber's guidance. For others, particularly those with chronic or recurrent conditions like bipolar disorder or recurrent major depression, long-term medication may be the most effective way to stay stable. The duration depends on your diagnosis, how many episodes you have had, and how you respond to treatment. Your prescriber will help you evaluate the right timeline and support you through any changes.

In most cases, no. You can contact a therapist directly and schedule an appointment without a referral. However, some insurance plans — particularly HMOs — may require a referral from your primary care doctor before they will cover sessions. Check with your insurance provider to find out what your plan requires.

You do not need to know before you start. A good therapist will assess your concerns during the first few sessions and recommend an approach that fits. If you want to do some research beforehand, look into evidence-based therapies for your specific concerns — for example, CBT is well-researched for anxiety, and EMDR is a leading treatment for trauma. But your therapist is the expert and will guide you.

There are several options. Many therapists offer sliding scale fees based on income. Community mental health centers provide low-cost services. Your employer may offer free sessions through an Employee Assistance Program (EAP). Some graduate training clinics offer therapy at reduced rates with supervised therapists-in-training. Open Path Collective and similar organizations also connect people with affordable providers.

No. Even if you use employer-provided health insurance, HIPAA prohibits your employer from accessing your individual health claims. Your insurance company processes the claims, but your HR department does not see what services you used. If you use an EAP, your participation is also confidential — the EAP provider cannot tell your employer that you specifically used the service.

It depends on the situation and the therapist. Some therapists are open to having a support person in the waiting room, and in certain cases a loved one may join part of a session if it would be helpful. However, individual therapy sessions are typically one-on-one. If having someone there is important to you, call the therapist's office ahead of time and ask about their policy.

You can switch. The therapeutic relationship is one of the most important factors in whether therapy works, and not every therapist will be the right fit for every person. Give it two or three sessions if possible, but if you consistently feel judged, dismissed, or uncomfortable, it is perfectly okay to find someone else. A good therapist will not take it personally.

For many conditions, yes. Research shows that online therapy is as effective as in-person therapy for common concerns like anxiety and depression. It also offers greater accessibility and convenience. That said, some people prefer the in-person experience, and certain situations — such as severe crisis or specific types of trauma work — may benefit from face-to-face sessions. The best format is the one you will actually use consistently.

Most people start with weekly sessions, which gives enough momentum to make progress without long gaps between appointments. As you improve, you and your therapist may move to biweekly or monthly sessions. Some intensive therapies, like DBT, may include multiple contacts per week. Your therapist will recommend a frequency based on your needs, but ultimately it is a decision you make together.

Therapy involves talking with a trained professional to understand and change patterns in your thinking, emotions, and behavior. Medication involves taking prescribed drugs that affect brain chemistry to reduce symptoms. They work differently, address different aspects of mental health, and are often most effective when used together. A therapist provides therapy; a psychiatrist or other prescribing provider manages medication.

It is normal to feel temporarily worse after discussing painful topics — bringing buried emotions to the surface can be uncomfortable. This is not a sign that therapy is failing; it is often a sign that you are engaging with important material. However, if you consistently feel worse over an extended period with no improvement, talk to your therapist about it. They can adjust the approach or help you find a better fit.

There is no minimum threshold for therapy. You do not need a diagnosis, a crisis, or a specific event to benefit. Many people come to therapy because they feel stuck, stressed, or uncertain — and those are completely valid reasons. If something is affecting your quality of life or your ability to enjoy your day-to-day, it is worth exploring with a professional.

Most therapists take brief notes during or after sessions to track your progress and remember key details. Under HIPAA, you have the right to request access to your therapy records, including these notes. Some therapists keep separate "psychotherapy notes" that have additional privacy protections, but you can still ask to see them. If you are curious about what your therapist is writing, just ask.

Most therapists have a cancellation policy that requires 24 to 48 hours of notice. If you cancel within that window or miss a session without notice, you may be charged a late cancellation or no-show fee. This fee is typically not covered by insurance. Your therapist will explain their specific policy at the start of treatment, so there are no surprises.

This varies by therapist. Some welcome brief messages for scheduling or quick check-ins, while others reserve communication for sessions only. Most therapists will not conduct therapy over text or email due to confidentiality concerns and the limitations of written communication. Ask your therapist about their between-session communication policy so you know what to expect.

You and your therapist will discuss this together. Signs that you may be ready to wrap up include consistently meeting your treatment goals, feeling equipped to handle challenges on your own, and noticing lasting improvements in your daily life. Ending therapy is a gradual process — most therapists will suggest spacing out sessions before stopping entirely, and you can always return later if you need to.

That is a perfectly valid reason to start therapy. You do not need to arrive with a clear diagnosis or a neatly defined problem. Feeling "off" — low energy, persistent unease, disconnection from things you used to enjoy — is often how people describe the early stages of depression, anxiety, burnout, or life transitions. A therapist can help you explore what is underneath that feeling and give it shape.

Almost everything, yes. Therapists are bound by law and professional ethics to keep what you share private. The exceptions are narrow and specific: if there is an imminent risk of harm to yourself or someone else, if there is suspected child or elder abuse, or if a court issues a legal order for records. Your therapist will explain these limits at the start of treatment so you know the boundaries upfront.

A therapist is a licensed mental health professional who provides talk therapy — this includes licensed clinical social workers, licensed professional counselors, and psychologists. A psychiatrist is a medical doctor who specializes in mental health and can prescribe medication. Some psychiatrists also provide therapy, but many focus primarily on medication management. You may work with both, depending on your needs.

Yes, and in many cases it is recommended. Therapy and medication address different aspects of mental health and often work better together than either one alone. Your therapist and prescribing provider can coordinate care to make sure your treatment plan is cohesive. Be sure to let your therapist know about any medications you are taking.

That is completely fine and happens all the time. Therapy is a space where you are allowed to feel and express your emotions without judgment. Your therapist will not be uncomfortable, surprised, or think less of you. Crying is a natural part of processing difficult feelings, and many people find that sessions where they cry are the ones where they make the most progress. There will be tissues available.

For many conditions, yes. A large body of research shows that online therapy is as effective as in-person therapy for treating anxiety, depression, PTSD, and several other common concerns. The therapeutic relationship — which is the strongest predictor of outcomes — can develop just as well over video. That said, individual preference matters. Some people find it easier to open up on screen, while others prefer being in the same room as their therapist. For a detailed comparison, see our article on [online vs. in-person therapy](/blog/online-vs-in-person-therapy).

You need a stable internet connection, a device with a camera and microphone (a laptop, tablet, or smartphone), and a private space where you will not be overheard or interrupted. Most therapists use a HIPAA-compliant video platform and will send you a link before your session. Headphones can help with both audio quality and privacy. Test your setup before your first session so you can troubleshoot any technical issues in advance. For a step-by-step walkthrough, see our guide on [how to prepare for an online therapy session](/blog/how-to-prepare-online-therapy-session).

Licensed therapists are required to use HIPAA-compliant platforms for telehealth sessions, which means the video and audio are encrypted and your session data is protected. Platforms like SimplePractice Telehealth, Doxy.me, and Zoom for Healthcare meet these requirements. Your therapist should never conduct sessions over regular FaceTime, Skype, or standard Zoom. Your responsibility is to ensure you are in a private location during your session — a room with a closed door and no one within earshot. For a detailed privacy guide, see our article on [online therapy security and HIPAA](/blog/is-online-therapy-secure).

In-person therapy may be preferable when you are in acute crisis and need immediate, hands-on support; when certain therapeutic techniques require physical presence (such as some forms of EMDR or somatic therapy); when you do not have access to reliable internet or a private space at home; or when you find it difficult to stay focused or feel connected through a screen. Some people also find that the act of going to a therapist's office creates a helpful separation between therapy and daily life. See our full comparison of [online vs. in-person therapy](/blog/online-vs-in-person-therapy). You can also learn more about specific modalities online in our articles on [EMDR online](/blog/can-you-do-emdr-online) and [somatic therapy online](/blog/somatic-therapy-online).

Most insurance plans now cover telehealth therapy sessions. Following the expansion of telehealth during the COVID-19 pandemic, the majority of states passed laws requiring insurers to cover teletherapy at the same rate as in-person visits. However, coverage can depend on your specific plan, the platform used, and whether the therapist is in-network. Call your insurance company to confirm that telehealth mental health services are covered under your plan before you begin. For Medicare-specific coverage details, see our article on [whether Medicare covers online therapy](/blog/does-medicare-cover-online-therapy).

Some therapists offer phone-only sessions, and research suggests phone therapy can be effective, particularly for conditions like depression and anxiety. However, many therapists prefer video because it allows them to observe body language and facial expressions, which provide important clinical information. Insurance coverage for phone-only sessions varies — some plans cover it, while others require video. If phone sessions are important to you, ask prospective therapists whether they offer this option. For a full comparison, see our article on [phone therapy vs. video therapy](/blog/phone-therapy-vs-video-therapy).

Many therapists offer a hybrid model where you can alternate between online and in-person sessions based on your schedule and preferences. This can be a practical arrangement — for example, attending in person when you can and switching to video when travel, illness, or weather makes it difficult. Discuss this option with your therapist to see if they support a flexible approach and whether your insurance covers both formats equally. Learn more in our article on [hybrid therapy: combining online and in-person sessions](/blog/hybrid-therapy-online-and-in-person).

These platforms can provide convenient access to licensed therapists, especially for people in areas with limited local options. However, there are important differences from traditional therapy: therapists on these platforms are often independent contractors with high caseloads, communication may be primarily text-based unless you opt for video sessions, and insurance is not always accepted. Privacy policies on some platforms have also drawn scrutiny. If you use one of these services, make sure you are comfortable with the terms and that the therapist is licensed in your state.

Generally, no. Therapists are licensed by state, and most state laws require that both the therapist and the client be in the state where the therapist is licensed during the session. Some states participate in the PSYPACT interstate compact, which allows psychologists to practice across member states. If you travel frequently or are considering a therapist in another state, ask about their licensure and whether any interstate agreements apply. For more details, see our guide to [PSYPACT and the counseling compact](/blog/psypact-counseling-compact-explained).

Technical issues happen occasionally. Most therapists have a backup plan — typically switching to a phone call if the video connection drops. If your internet is unstable, try connecting via ethernet instead of Wi-Fi, closing other apps and browser tabs, or moving closer to your router. Let your therapist know at the start of treatment what your preferred backup method is so you both know what to do if the connection fails. You will not be charged for time lost to technical difficulties in most cases.

Warning signs include persistent changes in mood or behavior lasting more than two weeks, withdrawal from friends or activities they used to enjoy, declining grades, changes in sleep or appetite, increased irritability or anger, substance use, self-harm, or talk of hopelessness. However, you do not need to wait for a crisis — therapy can also help teens navigate normal developmental challenges like identity formation, peer pressure, and academic stress.

The level of parent involvement varies depending on the teen's age, the issues being addressed, and the therapist's approach. Most therapists meet with parents periodically to provide updates and guidance while keeping the content of individual sessions confidential. For younger teens, parents are typically more involved. Your therapist will discuss their approach to parent involvement at the start of treatment.

Therapists generally keep the specific content of sessions confidential to maintain trust with the teen, which is essential for therapy to work. However, therapists are required to break confidentiality if there is a safety concern — such as suicidal thoughts, self-harm, abuse, or substance use that poses immediate danger. Most therapists discuss these boundaries clearly with both the teen and parents during the first session.

Resistance to therapy is common among teens and does not mean therapy will not help. Try to understand their specific objection — they may fear being judged, labeled, or having their privacy violated. Let them have a say in choosing their therapist, explain that they control what they talk about, and avoid framing therapy as punishment. Many teens who are initially reluctant become engaged once they realize the therapist is on their side.

Sessions are usually 45 to 50 minutes and look different depending on the teen's age and the therapist's approach. Younger teens may use creative activities, games, or worksheets as tools for discussion. Older teens typically engage in conversational therapy similar to adult sessions. The therapist builds rapport, helps the teen identify patterns in their thoughts and behaviors, and teaches coping skills. Sessions are collaborative, not lectures.

The duration depends on what the teen is dealing with. For a specific issue like adjustment to a new school or a mild anxiety problem, 8 to 12 sessions may be sufficient. More complex issues like depression, trauma, or family conflict may require several months of weekly sessions. Your therapist will set goals with your teen and reassess progress regularly.

Many schools offer counseling services through school counselors, school psychologists, or partnerships with community mental health organizations. School-based therapy has the advantage of convenience and no transportation barriers. However, school counselors often have limited availability and may not be trained in specific evidence-based treatments. For more complex issues, a referral to an outside therapist is usually recommended.

Yes. Research supports the effectiveness of online therapy for teens, and many adolescents actually prefer it because they are already comfortable communicating through screens. Online therapy can reduce barriers like transportation and scheduling conflicts with school. However, the therapist needs to ensure a private space is available for sessions, and some teens engage better in person.

Costs are similar to adult therapy — typically $20 to $75 per session with insurance, or $100 to $250 without insurance. Many insurance plans cover mental health services for minors, and some states have expanded coverage for adolescent mental health. School-based services are usually free, and community mental health centers offer sliding scale options. Check your plan's specific benefits for details.

Take any mention of suicide seriously. If your teen is in immediate danger, call 911 or take them to the nearest emergency room. For suicidal thoughts or emotional crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988. The Crisis Text Line is also available by texting HOME to 741741. Stay calm, listen without judgment, remove access to means if possible, and do not leave them alone. A crisis does not mean your teen is beyond help — it means they need support right now.

Signs vary by age but generally include persistent changes in behavior, mood, or functioning that last more than a couple of weeks. Watch for withdrawal from friends or activities they used to enjoy, sudden changes in academic performance, frequent tantrums or emotional outbursts beyond what is typical for their age, excessive worry or fearfulness, sleep or appetite changes, regression to earlier behaviors (like bedwetting), or talk of self-harm or death. Trust your instincts — if something feels off, a professional assessment can help clarify whether therapy would be beneficial.

Several evidence-based approaches are designed specifically for young people. [Play therapy](/treatments/play-therapy) uses toys, games, and creative activities to help younger children express feelings they cannot yet put into words. [Parent-Child Interaction Therapy (PCIT)](/treatments/parent-child-interaction-therapy-pcit) coaches parents in real time to improve the parent-child relationship. [Trauma-Focused CBT (TF-CBT)](/treatments/trauma-focused-cognitive-behavioral-therapy-tf-cbt) is a structured approach for children who have experienced trauma. For teens, CBT, DBT, and family therapy are commonly used. The therapist will recommend the best approach based on your child's age and specific needs.

This depends on the child's age, the type of therapy, and the therapist's approach. For younger children, parent involvement is typically high — approaches like PCIT and TF-CBT include direct parent participation. For adolescents, the therapist may meet primarily with the teen but schedule regular parent check-ins (monthly or as needed) to share general progress and recommendations. Being engaged without being intrusive is the goal. Ask the therapist at the outset how they handle parent involvement so expectations are clear.

For younger children, therapists generally share more information with parents about session themes and progress. For teenagers, most therapists establish a confidentiality agreement that keeps session content private unless there is a safety concern — such as suicidal thoughts, self-harm, substance abuse, or abuse by someone else. This privacy is important because it allows teens to speak honestly. Your therapist will keep you informed about overall progress and any safety issues without sharing specific details your teen discussed in confidence.

Be honest, calm, and age-appropriate. For younger children, you might say therapy is a place where they can talk to someone about their feelings and learn ways to feel better. For teens, be straightforward — explain that therapy is a normal, helpful resource, not a punishment or a sign that something is wrong with them. Avoid framing it as a consequence for bad behavior. Let them know their feelings about going are valid, and that many people — including adults — benefit from therapy. If they are resistant, acknowledge their feelings and give them some control over the process, such as having input on choosing the therapist.

Children as young as 2 or 3 can benefit from certain types of therapy, particularly [play therapy](/treatments/play-therapy) and [PCIT](/treatments/parent-child-interaction-therapy-pcit), which are specifically designed for very young children. These approaches do not require a child to have strong verbal skills. For older children and teens, a wider range of therapeutic approaches becomes available. There is no minimum age — if your child is struggling, a therapist who specializes in their age group can determine the best approach.

School-based therapy is provided at school during the school day, usually by a school counselor or a therapist contracted through the school system. It is often free and convenient but may be limited in scope, session frequency, or duration. Private therapy takes place in a therapist's office (or online) and allows for more specialized treatment, longer-term care, and greater privacy. School-based services can be a good starting point, and many families use both simultaneously — a school counselor for day-to-day support and a private therapist for deeper clinical work.

It depends on the issue and the type of therapy. Some structured approaches, like TF-CBT, are typically 12 to 25 sessions. Other concerns may require longer-term support. You should start to see signs of progress within the first several weeks — such as the child being more willing to attend, showing improved mood, or using new coping skills. Your therapist should discuss treatment goals and expected duration early on and provide updates on progress along the way.

Resistance is common, especially among teens. Start by listening to their concerns without dismissing them — they may fear being judged, losing control, or being forced to talk about things they are not ready to share. Offer them some agency in the process, such as choosing their own therapist or doing the consultation call themselves. Explain that therapy is confidential and that the therapist works for them, not against them. If they absolutely refuse, consider starting with family therapy (where the focus is not solely on them) or consulting a therapist yourself for guidance on how to approach the situation.

Yes. Therapy can address the underlying causes of behavioral problems — which often include anxiety, ADHD, trauma, social skills difficulties, or problems at home. A therapist can help your child develop coping strategies, emotional regulation skills, and better communication. Approaches like CBT and behavioral therapy are particularly effective for externalizing behaviors. With your consent, the therapist can also coordinate with your child's school to ensure consistent support across environments.

Look for a licensed therapist who specializes in children and adolescents — not all therapists are trained to work with young people. Check their experience with your child's specific concerns and ask about the therapeutic approaches they use. Use directories like Psychology Today and filter by age group and specialty. Schedule a consultation call to ask about their approach to parent involvement, confidentiality, and how they engage kids who may be reluctant. A good child therapist should feel warm, approachable, and experienced with the age group.

Consider couples therapy when communication has broken down, conflicts keep repeating without resolution, you feel emotionally disconnected from your partner, or a specific event (such as infidelity or a major life transition) has created a rift. You do not need to be in crisis to benefit — many couples seek therapy as a proactive measure to strengthen their relationship. In fact, research suggests couples wait an average of six years after problems begin before seeking help, and earlier intervention tends to produce better outcomes.

Yes, for the majority of couples. Research shows that evidence-based approaches like [Emotionally Focused Therapy (EFT)](/treatments/emotionally-focused-therapy-eft) and the [Gottman Method](/treatments/gottman-method) produce significant improvements in relationship satisfaction for 70 to 75 percent of couples. Success depends on several factors: both partners' willingness to engage, the skill of the therapist, and whether underlying issues (like untreated mental health conditions or active addiction) are also being addressed. Couples therapy works best when both partners are committed to the process.

It is not uncommon for one partner to be hesitant. If your partner is reluctant, start by going to individual therapy yourself to work on your own patterns and gain clarity. Sometimes when one partner starts making changes, the other becomes more open to participating. You can also ask your partner to commit to just one or two sessions before deciding — many people find that their concerns about therapy are eased once they experience it firsthand. A skilled therapist will create a non-judgmental space that does not feel like anyone is being blamed.

Yes, many couples recover from infidelity with the help of therapy. It is a long and difficult process — typically taking a year or more — but research shows that with skilled therapeutic support, many couples rebuild trust and even develop a stronger relationship than before. The therapist helps the couple process the betrayal, understand what led to it, and decide whether and how to move forward. Approaches like the [Gottman Method](/treatments/gottman-method) and [EFT](/treatments/emotionally-focused-therapy-eft) have specific protocols for affair recovery.

In a typical session, both partners sit with the therapist and work on specific relationship issues. The therapist may facilitate a structured conversation, help you identify patterns in how you interact, teach communication or conflict resolution skills, or guide you through emotional processing. Some sessions may feel intense as difficult topics surface. The therapist's role is not to take sides but to help both partners feel heard and to guide the relationship toward healthier dynamics. For a fuller overview, see our page on [couples therapy](/treatments/couples-therapy).

The length varies based on the issues and the approach. Some couples see meaningful improvement in 8 to 12 sessions, while more complex issues — such as infidelity recovery, long-standing communication problems, or navigating a major life transition — may require 6 months to a year or longer. Most couples therapists recommend weekly sessions, at least initially, to build momentum. Your therapist should establish clear goals early on and check in on progress regularly.

Individual therapy focuses on one person's thoughts, feelings, and behaviors. Couples therapy focuses on the relationship — the dynamic between two people, their communication patterns, and their shared issues. Sometimes a person benefits from both: individual therapy to work on personal concerns (like anxiety or childhood trauma) and couples therapy to address relational patterns. Most therapists recommend against using the same therapist for both individual and couples work, as it can create conflicts of interest.

[Emotionally Focused Therapy (EFT)](/treatments/emotionally-focused-therapy-eft) focuses on strengthening the emotional bond between partners by identifying and shifting negative interaction cycles. The [Gottman Method](/treatments/gottman-method) is a research-based approach that teaches specific skills for managing conflict, deepening friendship, and creating shared meaning. Other approaches include Imago Relationship Therapy, which explores how childhood experiences shape adult relationships, and Discernment Counseling, which helps couples on the brink of divorce decide whether to commit to therapy or separate. Your therapist will recommend the approach that fits your situation.

Research strongly supports premarital counseling. Couples who participate in premarital education programs show a 30 percent increase in relationship satisfaction and significantly lower rates of divorce. Premarital counseling helps you discuss important topics — such as finances, family planning, conflict styles, and expectations — before they become sources of conflict. It also gives you shared communication tools to draw on when challenges arise. Many couples find it one of the most valuable investments they make before marriage.

Absolutely. In fact, this is one of the best reasons to start. Many couples seek therapy not because the relationship is failing but because they want to communicate more effectively, resolve recurring disagreements, or deepen their connection. Working on communication before patterns become entrenched is both easier and more effective. Think of it as maintenance — much like going to a doctor for a check-up rather than waiting for an emergency.

Look for a licensed therapist who specializes in couples work and is trained in an evidence-based approach like EFT or the Gottman Method. Not all individual therapists are skilled at working with couples — it requires specific training. Ask about their experience with your particular issue, their approach to sessions, and how they handle situations where one partner feels blamed. Schedule a consultation call to gauge whether you both feel comfortable. Directories like the ICEEFT therapist finder (for EFT) and the Gottman Referral Network can help you locate certified practitioners.

In rare cases, couples therapy can feel counterproductive — for example, if a therapist lacks specific training in couples work, if sessions become a platform for one partner to attack the other, or if there is active domestic violence that has not been disclosed. A qualified couples therapist will screen for domestic violence and power imbalances before beginning joint sessions, because abuse dynamics require a different treatment approach. With a skilled, evidence-based practitioner, the vast majority of couples experience improvement rather than harm. If sessions consistently feel unproductive or unsafe, it is appropriate to raise that concern directly or seek a different therapist.

It is rarely too late, though timing does matter. Couples therapy can still help even when problems have persisted for years, as long as at least one partner retains some hope or investment in the relationship. The signs that suggest a more difficult road include complete emotional detachment from both partners, an unwillingness to engage in the process, or a firm decision to leave that has already been made. If you are unsure whether to work on the relationship or end it, [Discernment Counseling](/treatments/discernment-counseling) is specifically designed to help couples in that uncertain space before committing to full couples therapy.

Frame therapy as something you want to do together to strengthen the relationship — not as evidence that your partner needs to be fixed. Use 'us' language: 'I think we could benefit from learning better ways to communicate' rather than 'you need to talk to someone.' Suggest committing to just one or two sessions before making a judgment, since many reluctant partners find the experience far less intimidating than they expected. Share what you personally hope to gain, such as feeling more connected or resolving a specific recurring disagreement. Avoid using therapy as a threat or ultimatum, as that sets a counterproductive tone before you even begin.

The main differences are in licensing and training. A Licensed Marriage and Family Therapist (LMFT) completes a graduate program specifically focused on relational and family systems, making them well-suited to [couples therapy](/treatments/couples-therapy). Licensed Clinical Social Workers (LCSWs) and psychologists (PhDs or PsyDs) can also be excellent couples therapists if they have pursued additional training in couples-specific approaches. What matters more than the specific license is whether the therapist has specialized training in an evidence-based couples modality — such as [EFT](/treatments/emotionally-focused-therapy-eft) or the [Gottman Method](/treatments/gottman-method) — and substantial experience working with couples rather than only individuals.

Yes, and research shows that online couples therapy produces outcomes comparable to in-person sessions for most issues. Teletherapy can be especially convenient for couples with busy or conflicting schedules, and it removes the barrier of commuting together. The most important consideration is privacy — both partners need a space where they can speak openly without being overheard by children, roommates, or coworkers. In-person sessions may be preferable when issues are particularly high-conflict or when one or both partners struggle with the videoconference format.

A couples therapy intensive is a concentrated format in which you and your partner work with a therapist for extended blocks — typically 2 to 3 full days — rather than in weekly one-hour sessions. Intensives can cover the equivalent of several months of traditional therapy in a single weekend, making them a good option for couples in acute crisis, those with demanding schedules, or partners who travel from out of town for a specialist. They tend to cost more upfront (often $2,000 to $5,000 or more) but may reduce the total number of sessions needed. Approaches like the [Gottman Method](/treatments/gottman-method) and [EFT](/treatments/emotionally-focused-therapy-eft) both offer intensive formats.

Generally, no. When one therapist sees both partners individually and as a couple, it creates what is known as a dual relationship — the therapist may hear information in individual sessions that complicates their neutrality in couples work, and one or both partners may suspect bias. Most ethical guidelines recommend that each partner have a separate individual therapist if individual work is needed alongside [couples therapy](/treatments/couples-therapy). Exceptions sometimes exist in structured programs where brief individual check-ins are built into the couples treatment model, but even then, clear ground rules about confidentiality are essential.

[Emotionally Focused Therapy (EFT)](/treatments/emotionally-focused-therapy-eft) and the [Gottman Method](/treatments/gottman-method) have the strongest research base, with decades of clinical studies supporting their effectiveness. EFT focuses on reshaping the emotional bond between partners, while the Gottman Method emphasizes building friendship, managing conflict constructively, and creating shared meaning. That said, the best approach depends on your specific issues — for example, Discernment Counseling is better suited for couples unsure about staying together, and some therapists use an integrative approach that draws from multiple models. A qualified couples therapist can help you determine which approach fits your situation.

The most effective evidence-based treatments for PTSD are Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Eye Movement Desensitization and Reprocessing (EMDR). All three have strong research support and are recommended by the American Psychological Association and the VA. The best choice depends on your preferences, symptoms, and what your therapist recommends based on your specific situation.

EMDR uses bilateral stimulation (typically eye movements) while you briefly focus on the traumatic memory to help your brain reprocess it. Unlike traditional talk therapy, EMDR does not require you to describe the trauma in detail or complete homework assignments between sessions. Many people find EMDR processes traumatic memories faster than talk-based approaches, though both can be highly effective.

Not necessarily. While some trauma therapies like Prolonged Exposure involve recounting the traumatic event, approaches like EMDR and somatic therapies require much less verbal detail. A good trauma therapist will work at your pace and never force you to disclose more than you are ready to share. The goal is processing the trauma, and there are multiple effective paths to get there.

For a single-incident trauma (such as a car accident or assault), many people see significant improvement in 8 to 16 sessions. Complex trauma — especially childhood abuse or neglect — typically requires longer treatment, often several months to a year or more, because there are multiple layers to address. Your therapist will develop a treatment plan based on your specific history and goals.

Yes. PTSD can develop after any traumatic experience, including sexual assault, domestic violence, car accidents, natural disasters, childhood abuse or neglect, sudden loss of a loved one, medical trauma, or witnessing violence. Combat is just one of many causes. PTSD is defined by your response to an event, not the type of event itself.

It is normal to experience a temporary increase in distressing thoughts, emotions, or nightmares when you begin processing trauma — this is sometimes called a processing response. However, a skilled trauma therapist will pace the work to keep it manageable and will not push you beyond what you can handle. If you feel consistently destabilized or worse over several weeks, talk to your therapist about adjusting the approach.

Complex PTSD (C-PTSD) develops from prolonged, repeated trauma — often occurring in childhood or in situations where escape was not possible, such as ongoing abuse or captivity. It includes standard PTSD symptoms plus difficulties with emotional regulation, self-concept, and relationships. Treatment typically takes longer and often involves a phase-based approach: first stabilization and skill-building, then trauma processing, and finally reconnection and integration.

Body-based (somatic) trauma therapies like Somatic Experiencing, Sensorimotor Psychotherapy, and certain yoga-based interventions recognize that trauma is stored in the body as well as the mind. They work with physical sensations, movement, and body awareness to release traumatic stress. While the evidence base is still growing compared to CPT and EMDR, many clinicians and clients report meaningful results, especially for people who have difficulty processing trauma verbally.

Yes. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is the gold-standard treatment for children and adolescents who have experienced trauma. It is adapted to be developmentally appropriate and involves a caregiver component. Play therapy and other child-friendly approaches are also used with younger children. Early treatment is important because unresolved childhood trauma can affect development and lead to long-term difficulties.

Mental health care is organized into several levels based on intensity and structure. From least to most intensive, the main levels are outpatient therapy (weekly sessions), intensive outpatient programs (IOP), partial hospitalization programs (PHP), residential treatment, and inpatient hospitalization. Each level provides a different amount of supervision, therapeutic hours, and structure. The right level depends on the severity of your symptoms, your safety needs, and how much support you need to function day to day. For a comprehensive overview, see our [guide to levels of care](/guides/levels-of-care).

Inpatient treatment takes place in a hospital setting and is designed for acute psychiatric crises — such as active suicidal ideation, psychosis, or severe destabilization — where 24-hour medical monitoring is needed. Stays are typically short, ranging from a few days to two weeks. Residential treatment, on the other hand, takes place in a non-hospital facility and provides 24-hour therapeutic support in a more home-like environment. Residential programs focus on longer-term stabilization and skill-building, with stays lasting 30 to 90 days or more. The key distinction is that inpatient is for immediate safety and stabilization, while residential is for sustained, structured recovery. For a deeper comparison, see our article on [residential vs. inpatient treatment](/blog/residential-vs-inpatient).

A partial hospitalization program (PHP) is a structured, intensive treatment program where you attend therapy and programming for most of the day — typically five to seven hours — but return home or to a supportive living environment in the evening. PHP usually runs five days a week and includes a combination of individual therapy, group therapy, psychiatric monitoring, and skill-building activities. It is designed for people who need more support than weekly therapy or IOP can provide but do not require 24-hour supervision. PHP is often used as a step-down from residential or inpatient treatment, or as a step-up when outpatient therapy is not enough. For a detailed comparison of these program types, see our article on [PHP vs. IOP](/blog/php-vs-iop).

An intensive outpatient program (IOP) provides structured therapy several days per week, typically three to five days, for about three to four hours per session. IOP allows you to live at home and maintain some of your daily responsibilities while receiving a higher level of care than standard weekly therapy. Programming usually includes group therapy, individual sessions, psychoeducation, and skill development. IOP is commonly used for mood disorders, anxiety, substance use, eating disorders, and trauma recovery. It can serve as a step-down from PHP or residential treatment, or as a step-up when outpatient therapy alone is not enough. For a side-by-side comparison, see our article on [PHP vs. IOP](/blog/php-vs-iop).

In many cases, yes. One of the main advantages of IOP is that it is designed to be compatible with work, school, or caregiving responsibilities. Many programs offer morning, afternoon, or evening tracks to accommodate different schedules. That said, the time commitment is significant — typically nine to fifteen hours per week in programming alone, plus travel time. Some people find it manageable to continue working or attending school part-time during IOP, while others choose to take a temporary leave. Talk to the program about scheduling options before enrolling.

The length of residential treatment varies depending on the condition being treated, the severity of symptoms, and the specific program. Most residential programs last 30 to 90 days, though some specialized programs (particularly for eating disorders, complex trauma, or personality disorders) may run longer. Insurance coverage often plays a role in determining length of stay, as continued authorization is required at regular intervals. Your treatment team will work with you to determine the appropriate length of stay and develop a discharge plan that includes step-down care.

You may need a higher level of care if you are in crisis, your symptoms are significantly interfering with daily functioning, or you have not made progress with outpatient therapy despite consistent effort. Warning signs include being unable to work or attend school, escalating self-harm or suicidal thoughts, inability to care for yourself, or active substance use that you cannot manage on your own. A treatment center provides the structure, intensity, and round-the-clock support that outpatient therapy cannot. Your current therapist, psychiatrist, or primary care doctor can help you assess whether a higher level of care is appropriate. For more on recognizing when it is time, see our article on [signs you need a higher level of care](/blog/signs-you-need-higher-level-of-care).

Start by identifying what you need treatment for — whether it is depression, trauma, an eating disorder, substance use, or something else — and look for programs that specialize in that area. Check accreditation from organizations like the Joint Commission or CARF, and verify that the program is licensed in its state. Ask about the clinical team's credentials, the therapeutic approaches used, the staff-to-client ratio, and what a typical day looks like. Read reviews and, if possible, speak with alumni. Also confirm that the program accepts your insurance or offers financial assistance, and ask about their discharge planning process. For a detailed walkthrough, see our guide on [how to choose a treatment center](/blog/how-to-choose-treatment-center).

Accreditation is a voluntary process where an independent organization evaluates a treatment center against established standards of care, safety, and ethics. The two most widely recognized accrediting bodies for behavioral health programs are the Joint Commission (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF). Accreditation indicates that a facility has met rigorous standards and undergoes regular reviews. While accreditation is not a guarantee of quality, the absence of it should raise questions. Most reputable insurance companies require accreditation before they will approve coverage for a program.

Yes. Your therapist can assess whether you need a higher level of care and help you identify appropriate treatment centers. Many therapists maintain referral networks and can recommend programs they trust. They can also help coordinate the transition by sharing relevant clinical information (with your consent) to make the admissions process smoother. If your therapist suggests a higher level of care, take it seriously — clinicians do not make that recommendation lightly. You are not required to follow through, but it is worth exploring the options they suggest.

The admissions process typically begins with a phone call to the treatment center, during which a staff member will ask about your symptoms, history, current medications, and insurance coverage. Many programs conduct a clinical assessment, either over the phone or in person, to determine whether their program is the right fit. If you are admitted, the center will verify your insurance benefits and obtain prior authorization if needed. You will receive information about what to bring, what to expect on arrival, and any logistical details. The process can take anywhere from a few hours to several days depending on the program and insurance requirements.

Residential treatment is expensive, with costs typically ranging from $10,000 to $30,000 per month for in-network programs and $20,000 to $60,000 or more per month for out-of-network or luxury facilities. These costs cover housing, meals, therapy, psychiatric care, and 24-hour supervision. Insurance can significantly reduce out-of-pocket costs, but coverage varies widely by plan. Some programs offer sliding scale fees, scholarships, or financing options. Before committing to a program, get a clear breakdown of costs and confirm what your insurance will cover so you are not surprised by unexpected bills. For a full cost breakdown by level, see our article on [mental health treatment cost by level of care](/blog/mental-health-treatment-cost-by-level).

Most major insurance plans cover PHP and IOP, as they are recognized levels of care for mental health and substance use treatment. However, coverage depends on your specific plan, whether the program is in-network, and whether the insurance company determines the level of care is medically necessary. Prior authorization is usually required, and your insurance company may conduct periodic reviews to decide whether to continue coverage. Contact your insurance provider before enrolling to understand your benefits, including copays, deductibles, and any limits on the number of days covered. For more on navigating coverage, see our article on [whether insurance covers treatment centers](/blog/does-insurance-cover-treatment-centers).

Medicaid coverage for residential mental health treatment varies significantly by state. Some state Medicaid programs cover residential treatment for certain populations, such as children, adolescents, or individuals with substance use disorders. However, there is a federal rule called the IMD exclusion that limits Medicaid coverage for adults in residential mental health facilities with more than 16 beds. Some states have obtained waivers to work around this restriction. Contact your state Medicaid office or a treatment center's admissions team to find out what is covered under your specific plan.

Prior authorization is a process where your insurance company must approve a treatment or service before it will agree to pay for it. For higher levels of care like PHP, IOP, or residential treatment, the treatment center's clinical team submits documentation showing that the level of care is medically necessary based on your symptoms and history. The insurance company reviews this information and decides whether to authorize coverage, usually for a set number of days. Reauthorization requests are submitted at regular intervals to continue coverage. If authorization is denied, you have the right to appeal the decision.

If your insurance denies coverage, you have the right to appeal. Start by requesting a written explanation of the denial, including the specific criteria that were not met. Your treatment team can help you file an internal appeal by providing additional clinical documentation supporting the medical necessity of the recommended care. If the internal appeal is denied, you can request an external review by an independent third party. Many denials are overturned on appeal, especially when thorough clinical documentation is provided. In the meantime, ask the treatment center about self-pay options, payment plans, or alternative programs.

The first day typically involves an intake process that includes a comprehensive clinical assessment, a medical exam (including vitals and sometimes lab work), a review of your medications, and a meeting with your initial treatment team. Staff will go over program rules, your daily schedule, and your rights as a client. You may have your belongings checked for prohibited items. Many programs assign a peer mentor or buddy to help you get oriented. The first day can feel overwhelming, but the staff are experienced at helping new arrivals settle in. Most people begin participating in groups and activities within the first day or two.

Phone policies vary widely by program. Some residential programs restrict phone access entirely, especially during the first few days or weeks, to help you focus on treatment without outside distractions. Others allow limited phone time during designated hours. Programs that treat adolescents tend to have stricter phone and device policies. The rationale behind restricting phones is that constant connectivity can interfere with the therapeutic process and maintain unhealthy patterns. Ask about the phone policy before you arrive so you can set expectations with family, employers, and others.

Discharge planning should begin well before your last day and typically includes stepping down to a lower level of care, such as PHP, IOP, or outpatient therapy. Your treatment team will help you establish connections with outpatient providers, support groups, and any other resources you need to maintain your progress. Many programs offer alumni groups and check-in calls after discharge. The transition out of residential treatment is a vulnerable time, and having a solid aftercare plan in place significantly reduces the risk of relapse or symptom recurrence. For more on this transition, see our article on [what to expect after residential treatment](/blog/after-residential-treatment).

Step-down care refers to the planned, gradual transition from a more intensive level of treatment to a less intensive one. For example, someone who completes residential treatment might step down to PHP, then to IOP, and finally to outpatient therapy. Each step reduces the amount of structure and support while giving you the opportunity to practice the skills you learned in a real-world setting. Step-down care is considered a best practice because abruptly stopping intensive treatment without a transition plan increases the risk of relapse. Your treatment team will work with you to determine the appropriate pace of step-down.

No. While residential treatment is commonly associated with substance use disorders, it is also available for a wide range of mental health conditions, including depression, anxiety, PTSD, eating disorders, borderline personality disorder, bipolar disorder, and OCD. Many residential programs specialize in specific conditions or populations. Mental health residential treatment provides the same 24-hour structure and intensive therapeutic programming as addiction treatment but with a focus on the specific clinical needs of the population being served.

Yes. There are residential treatment programs designed specifically for children and adolescents. These programs provide intensive therapy, academic support, and structured daily routines in a supervised environment. They are typically recommended when a young person's symptoms are too severe for outpatient treatment or when safety concerns (such as self-harm, suicidal behavior, or aggression) cannot be adequately managed at home. Parents and families are usually involved in the treatment process through family therapy sessions and regular communication with the treatment team. Choosing a program for a minor requires careful research into the facility's licensing, accreditation, staff qualifications, and treatment philosophy.