Talk Therapies & Counselling

Key takeaways:

• Talk therapy is a general category of mental health treatments that uses conversation to address emotional concerns.

• There are many forms of talk therapy, also called psychotherapy or counselling, which may be used to manage difficult life events or mental health conditions on a short-term or long-term basis.

• Talk therapy may be used alongside medication to more fully manage mental health diagnoses. By combining these two treatments, individuals often experience better results.

What is talk therapy?

Talk therapy refers to any mental health treatment that uses conversational methods to address emotional and behavioral concerns. This type of treatment, more formally known as psychotherapy, has several intended purposes. ^[1] Talk therapy may ease distress from uncomfortable emotions, modify negative thought patterns, and replace unhealthy behaviors with those that are more supportive. There are many forms of talk therapy. The type of talk therapy someone receives depends on their preferences, geographic location, cultural values, symptom severity, and diagnosis. ^{[3] [2]} Some talk therapies require providers to have specialized training, so individuals need to consider this if they are looking for a specific type of talk therapy.

Are talk therapies and counselling the same thing?

Talk therapy is a broad term that is often used as a catch-all for counseling and psychotherapy. However, there are significant differences between psychotherapy and counseling that are worth noting. Psychotherapy is more in-depth and long-term, often focusing on understanding underlying factors such as past trauma or behavioral issues. Counselling tends to focus on short-term, present issues that can be resolved with quick tools or behavior-modifying techniques.

Talk therapy may also be called psychological therapy or talking treatment. ^[1] Since talk therapy is a very general term, some people instead use the names of specific talk therapy approaches (such as Cognitive Behavioral Therapy) when referring to this treatment.

Types of talk therapy

There are many types of talk therapy with varied purposes and areas of focus. These include: ^{[2] [3]}

• Analytic/psychoanalytic therapies: These focus on the unconscious mind, dreams, childhood experiences, and fantasies.

• Behavioral therapies: By exploring learned behaviors and past experiences, behavioral therapies help someone understand how to change unhealthy or harmful habits and manage underlying emotions.

• Cognitive-behavioral therapies: Similar to behavioral approaches, these therapies build on them to help someone recognize the connection among thoughts, feelings, and actions, identify and challenge unhelpful thoughts and behaviors, and replace them with more supportive ones.

• Creative arts therapies: These involve making music, drawing, acting out scenes from theater, or painting, alongside discussions of the emotions that arise.

• Dialectical therapies: Dialectical therapies assist with emotion regulation, mindfulness, self-injurious behavior management, distress tolerance, and relationship strengthening.

• Dynamic/psychodynamic therapies: These tap into the conscious mind (that controls our actions) and the unconscious mind by exploring feelings, thought patterns, and relationships.

• Humanistic therapies: Humanistic, or person-centered, therapies look at someone’s values, sense of self and purpose, worldview, and how that relates to their chosen path in life.

• Mindfulness therapies: These involve acknowledging the present moment and using relaxation techniques to practice non-judgment and self-compassion, observing thoughts, emotions, and sensations, and reducing unconscious responses to stress.

Therapy options for children

Talk therapy is a suitable treatment option for adolescents and children between the ages of 9 and 12. However, children younger than this will find more success with experiential mental health treatment options, such as play therapy. ^[1]

What is a therapy session like?

Most talk therapy sessions are scheduled in advance. Though the therapy hour is typically 50 minutes, some sessions may last up to 60 minutes. Individuals can opt for in-person, phone, or online sessions, depending on their preference and what their provider offers. ^[1] You will work with your provider to determine how often your sessions will be. Many people choose to receive talk therapy weekly or every other week.

Talk therapy sessions are structured differently depending on what approach a therapist uses. Many mental health professionals use a combination of talk therapy styles depending on the needs of their patients. Providers may refer to this as integrative, eclectic, blended, or holistic treatment. ^[2]

What to talk about in therapy

The focus of a talk therapy session is largely dependent on a patient’s needs and preferences. It is partly the patient’s responsibility to decide what feels important to discuss in therapy, and their provider offers guidance along the way while honoring the patient’s autonomy and agency. Discussions commonly cover an individual’s feelings in the present but may also delve into their relationships, current life situations, and past experiences. ^[1] Depending on what someone chooses to discuss, some of what is discussed in therapy may be overwhelming. But talk therapy doesn’t need to focus directly on traumatic events and can be structured however the patient and provider wish.

What can talk therapy and counselling help with?

Counselling is known to help with various chronic and short-term stressors in a person’s life, including but not limited to: ^{[2] [5]}

• Death and bereavement.

• Relationship problems.

• The presence of ongoing physical symptoms with seemingly no explanation.

• Individuals may begin talk therapy after seeking help from doctors, who are unable to find the cause of their symptoms. Common physical symptoms that may lead someone to seek mental health treatment may include changes in sleep patterns, increased or decreased appetite, low energy, and restlessness.

• Life transitions, such as moving or graduating.

• Occupational burnout and other career-related problems.

• Caregiving for a family member with a chronic illness.

• Emotional distress directly related to past experiences.

• Difficulty managing or adjusting to chronic or terminal physical illness.

• Ongoing concerns such as low or worsening self-esteem, explosive anger, or intense shame.

Talk therapy for mental health conditions

Other individuals may receive talk therapy as a way to manage a diagnosed mental health condition. This may be per the recommendation of a healthcare provider or due to their own desire for treatment. Some mental health concerns that may benefit from psychotherapy include: ^{[1] [4]}

• Anxiety disorders, such as social anxiety and phobias.

• Bipolar disorder.

• Borderline personality disorder (BPD).

• Eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED).

• Insomnia.

• Major depressive disorder (MDD).

• Obsessive-compulsive disorder (OCD).

• Personality disorders.

• Post-traumatic stress disorder (PTSD).

• Schizophrenia.

• Self-harm behaviors.

• Substance use disorders (SUD).

• Suicidal ideation.

Long vs short-term counselling

Some forms of talk therapy are intended to be long-term. This is the case for psychoanalytic and psychodynamic therapy. Traditionally, people receiving psychoanalytic therapy may participate in sessions for years. Other modalities, such as cognitive-behavioral therapies, are short-term and have distinct start and end points. ^[3] The length of time someone receives talk therapy is also dependent on their diagnosis. Individuals with complex or long-standing diagnoses, such as severe PTSD or personality disorders, may engage in therapy for years to work through various concerns. Individuals with depression or phobias may instead participate in talk therapy for a few months.

Alternatives to therapy

While evidence supports the use of talk therapy for many life events and mental health concerns, other mental health treatments may be a better fit for some people. There are several alternatives to talk therapy. Mental health treatment options that are not based on traditional counselling or conversation include:

• Acupuncture.

• Animal-assisted therapy.

• Aromatherapy.

• Art therapy.

• Dance therapy.

• Eye movement desensitization and reprocessing (EMDR).

• Herbal medicine.

• Horticulture therapy.

• Hypnotherapy.

• Massage therapy.

• Music therapy.

• Nature-based therapy.

It is important to note that there is limited evidence for many of these modalities. However, this is not the case for all alternatives to talk therapy. EMDR has a strong evidence base. Acupuncture, art therapy, and music therapy are distinct practices with a growing evidence base that professionals use to address mental health concerns.

Therapy and medication

Many individuals see positive results from a combination of talk therapy and mental health medications. In fact, mental health professionals may recommend both talk therapy and psychotropic medication as the primary interventions to help manage a person’s mental health concern(s). ^[6] Some mental health professionals, such as psychiatrists or psychiatric/mental health nurse practitioners, can prescribe medications to the patients they work with. In other cases, mental health providers may need to refer their patients to a prescribing professional for this purpose.

Medications are primarily intended to provide relief from mental health symptoms, especially those that have become so severe that they impact someone’s ability to function. Once someone’s symptoms begin to ease with medication, they may be able to participate more fully in talk therapy. Despite this relief, medication will not change someone’s core feelings or thought patterns, which means they may still engage in unhealthy behaviors, coping mechanisms, and harmful habits. Therefore, a combination of these modalities usually yields better results than any single treatment.

Where to find therapy

If you would like to participate in talk therapy, you might start by speaking with your primary care doctor. They can refer you to a provider in your region who specializes in the concerns you are looking to address. Your doctor will connect you with someone in-network with your health insurance plan, which means your insurance may reimburse you for some or all of the cost. If your provider is unaware of specific providers, you can always contact your insurance carrier directly to find a mental health professional. If you have insurance through your employer, you can explore mental health benefits, such as an EAP (employee assistance program), which may offer several free therapy sessions.

Individuals without insurance who need reduced-cost options can dial 211 (in the United States) at any time to get information about providers and organizations in their community. You can also search for a provider yourself and pay out of pocket. Mental health evaluations may cost anywhere from $150 to $500, depending on where you live and whether you have insurance coverage. Talk therapy sessions may cost between $50 and $150 per visit.

FAQs about talk therapy and counselling

Who can perform talk therapy?

You can receive talk therapy from a psychiatrist, psychologist, social worker, marriage and family therapist, or professional counsellor. Each of these providers has professional training and an educational background in mental health, making them qualified to address a range of mental health concerns.

When should I speak to a therapist?

Speaking to a therapist is a good idea if you have difficulty dealing with your daily responsibilities, experience emotional distress that you cannot manage, or have negative thoughts or behaviors that feel out of your control. New or worsening symptoms can be a sign it’s time to reach out for help. If you have just been diagnosed with a mental health condition, that is also a good time to speak with a therapist.

Can I read my therapy notes?

Yes, you can request and read the notes your provider takes after your talk therapy sessions. If your therapist feels that reading your therapy notes would be harmful to the progress you are making, they have the right to decline your request.

How do I find a good provider for talk therapy?

You need to consider which type of talk therapy is best for you before finding a provider. You should also determine if you have any preferences for your therapist, such as wanting to work with someone of the same age, gender, sexual orientation, religion, or ethnic background. If you are seeking private talk therapy, you should also look into a provider’s fees and any requirements they set for visit frequency. You can always request a consultation with a provider to ask questions and get a sense of their experience, helping you determine whether they may be a good fit.

What questions should I ask the therapist during my first visit to talk therapy?

You can ask what to expect during sessions, what approaches they use, what training and experience they have supporting concerns similar to yours, and if there will be any homework. It is also good to know how to contact them if you need to adjust your visit or in the event of an emergency.