Does therapy actually work?

It’s Thursday again, and you’re back in the chair by the window. The tissues are where they always are. Your therapist asks how the week went, and you hear yourself give nearly the same answer as last time. Somewhere around minute thirty a small, slightly guilty question turns up: is any of this doing anything?

For many people it is. For quite a few, it isn’t yet. Before the numbers, try a guess.

The question is based on hundreds of trials of therapy for depression, pooled into one review. “Clearly better” meant your symptoms had dropped by at least half within about two months. That’s a high bar, which is partly why the real share is lower than many people expect.¹

Depression has the clearest numbers, not the only good ones

Depression is where most trials have been run, so it’s where the clearest numbers come from. Across many different problems, therapy tends to help strongly with panic, social anxiety, phobias and the aftermath of trauma, and less strongly with psychosis and long, heavy grief.² In children and teenagers, the benefits for depression are smaller than in adults.³

Some bad patches lift without therapy, so trials allow for that

In the same review, a little under 2 in 10 people who had no therapy were still clearly better at two months. Trials therefore put people who had therapy next to similar people who waited on a list or carried on with their usual care. About two months in, the two groups looked like this:¹

• Clearly better: about 4 in 10 people who had therapy, against fewer than 2 in 10 without it.
• Well enough to count as recovered for now: about 1 in 3 with therapy, against about 1 in 10 without it.
• Worse than when they started: a small group with therapy, and a bigger one without it.

So some people do get worse while in therapy, but going without it carried the bigger risk of sliding.¹

Does it matter which kind you pick?

Search for a therapist and you’ll meet a menu. CBT works on the links between your thoughts, feelings and habits. Psychodynamic therapy looks for old patterns that keep repeating. Interpersonal therapy focuses on your relationships. Each sounds as if it should suit a different sort of person.

For depression, the choice seems to matter far less than that menu suggests. CBT has been tested most by a long way, in about half of all depression trials.³ Against usual care or a waiting list it clearly helped, and the benefit still showed 6 to 12 months later. Next to that, the gap between CBT and other proper therapies was tiny, so small that most of the researchers’ checks couldn’t find it at all.⁴

Getting on with your therapist went with better results

In one of the biggest reviews on this, the better client and therapist got on, the better therapy tended to go. “Getting on” here means trusting each other and agreeing on what you’re working on. It held face to face and online, in many types of therapy and in many countries, and hardly any results pointed the other way.⁵

None of this proves the bond causes the progress. People who are already starting to feel better may simply warm to their therapist more. Still, the bond kept turning up in study after study, while the gap between one kind of therapy and another stayed tiny.^{4, 5}

To see what happened when researchers took CBT apart, or kept only the listening, watch the video What is CBT? Is therapy just paying someone to listen?

If you’re months in and still unsure

More than half of people are not clearly better at two months.¹ If smaller gains count as well as the big drop used above, decades of research put the share who improve or recover at about two thirds. That still leaves about 1 in 3 who don’t.⁶

About 1 in 5 people stop therapy early. It happens more often among younger clients and among people seeing therapists who are still in training, and the type of therapy makes no difference to it.⁷

Some things you can do, roughly in this order:

1. Say it in the session. “I’m not sure this is working” gives your therapist something real to work with, and it’s often easier to say early than after months of polite Thursdays.
2. Ask how progress is being checked. Some therapists track how you’re doing from session to session, often with a short questionnaire, and doing that helps catch people who are stuck or getting worse early on.⁶ If nobody is checking, you can ask to start.
3. Try someone else, or something else, before you decide therapy isn’t for you. A bond depends on two people, so the same problem may go differently with another therapist.⁵ A different approach can help too. In one English trial, a simpler method called behavioural activation did as well as CBT, as the next part shows.⁸
4. If you’re still on a waiting list, keep your usual days going. Keep the small plans you can manage, like work, meals and seeing people. The worry time tool lets you sort each worry by whether there’s one small step you can take today. Being put on a waiting list may itself lower your mood a little, though the studies on this are weak.⁹ If you feel worse while you wait, tell your GP or the service you’re waiting for.
5. Ask a doctor about medication. On average it helps about as much as talking therapy.¹⁰ If you’re already taking pills for depression, adding talking therapy tends to help more than pills on their own.⁴

Does the helper need a psychology degree?

A trial in Devon, Durham and Leeds, in England, put this to the test. It followed a few hundred adults with depression, split into two groups. One group got CBT from fully trained therapists. The other got behavioural activation from junior mental health workers with much shorter training. Behavioural activation is a simpler method that helps you slowly bring back the activities and plans that depression has pushed out of your life. Every two weeks the workers talked their cases through with an experienced therapist.⁸

A year later both groups had the same scores. People at immediate risk of suicide and people with some serious conditions, such as psychosis, were left out, so the trial says nothing about them.⁸

Sources (10)

1. Cuijpers, P., Karyotaki, E., Ciharova, M., Miguel, C., Noma, H., and Furukawa, T. A. (2021). The effects of psychotherapies for depression on response, remission, reliable change, and deterioration: a meta-analysis. Acta Psychiatrica Scandinavica, 144(3), 288-299. Read the study Back to the text
2. Harrer, M., Miguel, C., van Ballegooijen, W., et al., and Cuijpers, P. (2025). Effectiveness of psychotherapy: synthesis of a “meta-analytic research domain” across world regions and 12 mental health problems. Psychological Bulletin, 151(5), 600-667. Read the study Back to the text
3. Cuijpers, P., Harrer, M., Miguel, C., Ciharova, M., and Karyotaki, E. (2025). Five decades of research on psychological treatments of depression: a historical and meta-analytic overview. American Psychologist, 80(3), 297-310. Read the study Back to the text
4. Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., and Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105-115. Read the study Back to the text
5. Flückiger, C., Del Re, A. C., Wampold, B. E., and Horvath, A. O. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy, 55(4), 316-340. Read the study Back to the text
6. Lambert, M. J. (2013). Outcome in psychotherapy: the past and important advances. Psychotherapy, 50(1), 42-51. Read the study Back to the text
7. Swift, J. K., and Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: a meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547-559. Read the study Back to the text
8. Richards, D. A., Ekers, D., McMillan, D., et al. (2016). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. The Lancet, 388(10047), 871-880. Read the study Back to the text
9. Furukawa, T. A., Noma, H., Caldwell, D. M., et al. (2014). Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatrica Scandinavica, 130(3), 181-192. Read the study Back to the text
10. Leichsenring, F., Steinert, C., Rabung, S., and Ioannidis, J. P. A. (2022). The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry, 21(1), 133-145. Read the study Back to the text