Before you hire a therapist for you or your family, there are a few basic facts about psychological therapy that readers should know about:

Psychotherapy fact #1: Needing psychotherapy does not make you abnormal

Almost the entire adult population needs counseling at one time or another, even counselors themselves. So seeking psychotherapy does not make you weak or crazy. It makes you prudent. We all have times where it’s helpful to talk over our problems with someone else. That said …

Psychotherapy fact #2: You don’t always need it

“With a good therapist, significant benefit can often come in just a few sessions.” – Bloomfield, Colgrove & McWilliams (2000, p. 98)

Therapy isn’t always necessary. In fact, most of the time it isn’t. Most people recover from adverse events without any professional help, in their own manner and along their own time frame. If you go off what the research on resiliency shows, in most instances, less than a third of people will develop any type of serious symptomatology to begin with, indicating that at least two-thirds will be fine on their own. Whether you’re talking about children or adults, people are generally resilient, and seeking professional help may be of little to no benefit for much of the population. For example, one study found that 4 in 10 people who lost a loved one would have been better off WITHOUT grief counseling. (Begley, 6-23-2007) Since patients often improve on their own, (1/2 of all depressive episodes last less than 13 weeds, for example), therapists often get credit for improvement that would have occurred on their own. (Begley, 2015)

Other studies have found that therapies can help, but show no significant benefit over simply talking things out with friends or family. A competent therapist who uses evidence-based techniques will always be an asset during times of turmoil. But professional help certainly isn’t necessary for recovery in every case, or even the majority of cases.

Psychotherapy fact #3: Therapy does not need to be drawn out

“Studies of brief and solution-focused therapies show significant results after as few as two sessions,” writes Margarita Turragona in Psychology Today (2010). “Even therapies that are designed to be long-term show their greatest effectiveness within the first few months of treatment.” There is a widespread myth that psychological therapy needs to be long and drawn out. In fact, most evidence-based therapies can produce results in a dozen sessions or less. Competent and honest therapists may terminate the process after a single session if a child seems to be processing an event in healthy ways. There should be no set time frame to follow, since each case is unique, but you should understand that healing does not require a long or drawn out process. Therapists who keep their patients on the hook for years dealing with a single trauma or long past events should be fired, since they are obviously not doing their job. If they were competent, their patients would have healed years ago.

Psychotherapy fact #4: The type of therapy psychologists offer is not necessarily the most effective, and many do not use evidence-based techniques

One of the great frustrations in the field of psychology is that as research has opened up wonderful new insights about how the brain works and how people can improve their mental health, this knowledge has been extremely slow to be adapted into actual practice. As science journalist Sharon Begley writes, “For years, psychologists who conduct research have lamented what they see as an antiscience bias among clinicians, who treat patients.” (Begley, 10-12-2009) An analysis published in Perspectives on Psychological Science found that many clinicians fail to “use the interventions for which there is the strongest evidence of efficacy” and instead “give more weight to their personal experiences than to science.” Psychologist Walter Mischel, who wrote an editorial for the aforementioned study, comments that “the disconnect between what clinicians do and what science has discovered is an unconscionable embarrassment,” and laments what he sees as a “widening gulf between clinical practice and science.” (ibid)

This does not mean psychotherapy is bogus. In fact, proven therapies routinely outperform medications in improving mental health or even managing pain. It just means that the best psychologists who practice evidence-based methods are mixed in with those who do not. Methods such as cognitive behavioral therapy have been repeatedly proven to be effective in clinical trials, and are also ‘scientifically plausible,’ meaning it’s a therapy that fits well within our established knowledge of the brain and human behavior. Yet many of the country’s 93,000 psychologists don’t use these methods, and may not even understand the science behind them. (Baker, McFall & Shoham, 2008) Summarizing their research, the aforementioned authors write that “considerable evidence indicates that many, if not most, clinicians view science or research as having relatively little relevance to their practice activities…they privilege their intuition and informal problem solving over what the research literature has to offer.” Like Oprah or Dr. Phil, they dish out pop psychology nonsense based on personal feelings or hunches, and often give advice that directly contradicts research or is simply factually untrue.

Psychotherapy fact #5: Psychotherapy is a business

While few therapists would intentionally jeopardize the health of their patient, therapy is a business. Unfortunately, there is a rather perverse incentive behind the economy of psychotherapy: If you get better, therapists lose business. Their livelihood may depend NOT on healing your child quickly (in which case they lose a customer), but on you coming back in week after week for years to come. Again, while we don’t believe therapists as a whole intentionally bait and hook their patients, decades of psychological research has shown that people readily rationalize their actions according to their financial interests, whether it is working for a cigarette company or the effects of lobbyists in Washington. So keep this in mind, and realize that therapists may have a tendency to extend therapy when it isn’t needed or push it on circumstances when it isn’t helpful.

Psychotherapy Fact #6: Patients belief impacts therapy

 Much of the improvement in therapy is due to the placebo effect and the social connection with the therapist, and even the mere prospect of receiving help can boost psychological health. For example, a 1986 study found that 15% of patients improved in the time between their first phone call and first session. It’s estimated that the placebo effect probably accounts for around 1/2 the psychotherapy’s effectiveness. (Begley, 2015)