Psychology › Therapy & treatment
Talk therapy (psychotherapy)
Since 1895; proven 1977· Therapy or method
Well replicatedStrong, repeated evidence.
Structured conversation with a trained professional to relieve distress and change patterns of thinking, feeling and behavior.
See it on the Psychology map →What it says
Modern talk therapy began with Josef Breuer and Sigmund Freud's Studies on Hysteria (1895); a patient called it 'the talking cure'. In 1952 Hans Eysenck claimed therapy did no better than time alone. In 1977 Mary Lee Smith and Gene Glass pooled 375 studies in one of the first meta-analyses: the average treated person ended better off than about 75 percent of untreated people. Main forms include psychodynamic, cognitive behavioral, humanistic, interpersonal and family therapy.
Why it matters
Talk therapy works about as well as medication for depression and anxiety, with gains that tend to last after it ends. The fit with the therapist matters.
The evidence
Thousands of controlled trials and meta-analyses; research also shows the therapist-patient working alliance consistently predicts outcomes across methods.
Open questions
The 'Dodo bird' debate: do different therapies work equally well through shared factors, or do specific techniques, like exposure for phobias, matter most? Evidence suggests both play a part.
Inside this (3)
Connections (6)
▸Talk therapy (psychotherapy) traces its modern roots to PsychoanalysisWell replicated
The connection
Before Freud, healers used hypnosis, suggestion and humane 'moral treatment'. Breuer and Freud's cathartic method, then psychoanalysis, set the model of regular, private conversations aimed at understanding and changing inner life, which later talk therapies adapted or rebelled against.
Who showed it and when
Vienna, 1895 (Studies on Hysteria) and after; Freud's movement spread through Europe and, by the 1940s, dominated American psychiatry.
The evidence
Aaron Beck and Albert Ellis, founders of the cognitive therapies, both trained as psychoanalysts before breaking away; the history is well documented.
Open questions
How much credit belongs to Freud versus earlier figures such as Pierre Janet, who described similar ideas, is debated among historians.
▸Talk therapy (psychotherapy) effectively treats many Mental disorders: what they are and how commonWell replicated
The connection
Talk therapy helps across many disorders: CBT and related methods for depression, anxiety, OCD, PTSD, insomnia and eating disorders; DBT for borderline personality disorder; family therapy for teen anorexia. For mild to moderate depression and anxiety it is about as effective as medication, with lower relapse after treatment ends.
Who showed it and when
Evidence built from the 1970s onward through thousands of trials; Pim Cuijpers in Amsterdam has led many of the major meta-analyses.
The evidence
Meta-analyses of hundreds of controlled trials show moderate to large benefits, though effects are smaller in the highest-quality studies.
Open questions
Effects may be inflated by unpublished null results; why some people do not respond, and how to match people to therapies, are open questions.
▸The therapeutic alliance predicts success in Talk therapy (psychotherapy)Well replicated
The connection
Across many kinds of talk therapy, clients who agree with their therapist on goals and methods and feel a trusting bond tend to improve more. This shared ingredient helps explain why very different therapies often produce similar results.
Who showed it and when
Measured from the late 1970s by Edward Bordin, Lester Luborsky, Adam Horvath and others; pooled in meta-analyses from 1991 to 2018.
The evidence
A 2018 meta-analysis led by Christoph Flückiger, pooling 295 studies and more than 30,000 patients, found a consistent moderate correlation, about 0.28, between alliance and outcome.
Open questions
Correlation is not cause: clients who improve early may then rate the alliance higher. Session-by-session studies suggest the influence runs both ways.
▸Psychodynamic therapy is one major form of Talk therapy (psychotherapy)Mixed evidence
The connection
Psychodynamic therapy is one of the main families of talk therapy, alongside cognitive behavioral, humanistic, interpersonal and family approaches. It is less structured than CBT and focuses more on emotions, relationships and the past; it remains common in private practice and in Europe.
Who showed it and when
Practiced worldwide; in Germany, public health insurance has covered psychoanalytically based therapy since 1967.
How solid is it?
Surveys of therapists show many use psychodynamic ideas, and meta-analyses place its outcomes in the range of other established therapies.
Open questions
Researchers debate whether it is underrated because fewer trials test it, or rightly ranked below CBT for anxiety disorders.
▸Person-centered therapy (Carl Rogers) is one major form of Talk therapy (psychotherapy)Mixed evidence
The connection
Person-centered therapy is one of the main families of talk therapy, alongside psychodynamic, cognitive behavioral and family therapy. Its listening methods, reflecting feelings and withholding judgment, are now part of basic training in nearly every approach, even where the full method is not used.
Who showed it and when
Rogers introduced it in Counseling and Psychotherapy (1942); it spread through counseling centers, schools and pastoral care from the 1950s.
How solid is it?
It appears in standard textbooks and guidelines; England's NHS offers 'Counselling for Depression' based on it, and trials show it helps depression.
Open questions
It has fewer rigorous trials than CBT, so whether it matches CBT for moderate to severe depression is still debated.
▸Cognitive behavioral therapy (CBT; Beck, Ellis) is the most tested form of Talk therapy (psychotherapy)Well replicated
The connection
CBT's short, structured, manual-based format made it easy to test in randomized trials, so it built up more evidence than any other talk therapy. That evidence made it the default recommendation in many clinical guidelines and government-funded programs.
Who showed it and when
Trials began with Beck's team's 1977 depression study in Philadelphia; there are now hundreds of trials for depression alone and thousands overall.
The evidence
Meta-analyses by Pim Cuijpers and others, and Stefan Hofmann's 2012 review of 269 meta-analyses, document the size of the evidence base.
Open questions
Most tested is not the same as best: in head-to-head comparisons, other well-run therapies often perform similarly, the so-called Dodo bird debate.