COVID-19 taught most people that the line between tolerable and toxic stress – defined as persistent demands that lead to disease – varies widely. But some people will age faster and die younger from toxic stressors than others.

So how much stress is too much, and what can you do about it?

I’m a psychiatrist specializing in psychosomatic medicine, which is the study and treatment of people who have physical and mental illnesses. My research is focused on people who have psychological conditions and medical illnesses as well as those whose stress exacerbates their health issues.

I’ve spent my career studying mind-body questions and training physicians to treat mental illness in primary care settings. My forthcoming book is titled “Toxic Stress: How Stress is Killing Us and What We Can Do About It.”

A 2023 study of stress and aging over the life span – one of the first studies to confirm this piece of common wisdom – found that four measures of stress all speed up the pace of biological aging in midlife. It also found that persistent high stress ages people in a comparable way to the effects of smoking and low socioeconomic status, two well-established risk factors for accelerated aging.

The difference between good stress and the toxic kind

Good stress – a demand or challenge you readily cope with – is good for your health. In fact, the rhythm of these daily challenges, including feeding yourself, cleaning up messes, communicating with one another and carrying out your job, helps to regulate your stress response system and keep you fit.

Toxic stress, on the other hand, wears down your stress response system in ways that have lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his bestselling book “The Body Keeps the Score.”

The earliest effects of toxic stress are often persistent symptoms such as headache, fatigue or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown illness with a life of its own – such as migraine headaches, asthma, diabetes or ulcerative colitis – may surface.

When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune themselves and play in unison without our conscious effort – a process called self-regulation. But when we are sick, some parts of this orchestra struggle to regulate themselves, which causes a cascade of stress-related dysregulation that contributes to other conditions.

For instance, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has a difficult time regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts and behaviors.

‘Treating’ stress

Though stress neuroscience in recent years has given researchers like me new ways to measure and understand stress, you may have noticed that in your doctor’s office, the management of stress isn’t typically part of your treatment plan.

Most doctors don’t assess the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease and obesity, partly because stress is complicated to measure and partly because it is difficult to treat. In general, doctors don’t treat what they can’t measure.

Stress neuroscience and epidemiology have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during vulnerable periods such as childhood.

Over the past 40 years in the U.S., the alarming rise in rates of diabetes, obesity, depression, PTSD, suicide and addictions points to one contributing factor that these different illnesses share: toxic stress.

Toxic stress increases the risk for the onset, progression, complications or early death from these illnesses.

Suffering from toxic stress

Because the definition of toxic stress varies from one person to another, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to four or more adverse events in childhood. This is the threshold for higher risk for illnesses in adulthood.

Research dating back to before the COVID-19 pandemic also shows that about 19% of adults in the U.S. have four or more chronic illnesses. If you have even one chronic illness, you can imagine how stressful four must be.

And about 12% of the U.S. population lives in poverty, the epitome of a life in which demands exceed resources every day. For instance, if a person doesn’t know how they will get to work each day, or doesn’t have a way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats may keep them on high alert or shut them down in a way that prevents them from trying to cope at all.

Add to these overlapping groups all those who struggle with harassing relationships, homelessness, captivity, severe loneliness, living in high-crime neighborhoods or working in or around noise or air pollution. It seems conservative to estimate that about 20% of people in the U.S. live with the effects of toxic stress.

Recognizing and managing stress and its associated conditions

The first step to managing stress is to recognize it and talk to your primary care clinician about it. The clinician may do an assessment involving a self-reported measure of stress.

The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, called “lifestyle medicine,” focuses on improving health outcomes through changing high-risk health behaviors and adopting daily habits that help the stress response system self-regulate.

Adopting these lifestyle changes is not quick or easy, but it works.

The National Diabetes Prevention Program, the Ornish “UnDo” heart disease program and the U.S. Department of Veterans Affairs PTSD program, for example, all achieve a slowing or reversal of stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months. These programs help teach people how to practice personal regimens of stress management, diet and exercise in ways that build and sustain their new habits.

There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. The next steps include finding ways to expand the recognition of toxic stress and, for those affected, to expand access to these new and effective approaches to treatment.

The last client of the day leaves. You close the office door, sit down, and realize you cannot remember much of the past hour. Not because the session went badly. It went fine, and you were running on the last of your reserves the entire time. That flat, foggy, slightly detached feeling is one of the quiet ways therapist burnout shows up, and it rarely announces itself out loud.

Therapists, counselors, social workers, and psychologists are trained to hold space for other people. Very few of us are trained to ask for the same in return. Peer support changes that, and the research on clinician burnout keeps circling the same idea: we do better when we are not carrying the work alone.

What Therapist Burnout Actually Looks Like

Burnout is not the same thing as a hard week. A hard week ends. Burnout settles in and starts shaping how you think about your work, your clients, and yourself. It can look like competence on the outside and depletion on the inside, which is exactly why it goes unnoticed for so long.

Common signs in clinical practice include:

• Feeling emotionally numb or detached during sessions you used to find meaningful
• Dreading the calendar, or noticing relief when a client cancels
• Shorter fuse with clients, colleagues, or family
• Intrusive worry about a case that follows you home
• Physical signals such as headaches, sleep changes, or constant fatigue
• Cynicism about the field, your clients, or your own effectiveness
• Difficulty concentrating, documenting, or finishing notes on time

None of these mean you are bad at your job. They mean the load has outpaced the support holding it up.

A Number That Deserves Our Attention

In a survey of 550 therapists and counselors, 52% reported experiencing burnout in the past year. More than half. That is not a small, quiet minority of struggling clinicians. It is the middle of our profession, and it is happening in a role where admitting depletion can feel like a professional failure.

The stakes are real. Peer workers, who bring lived experience to behavioral health and recovery settings, face high risks of burnout, emotional exhaustion, and turnover when organizations are not prepared to meet their unique needs and do not offer intentional support. The same pattern shows up across mental health practitioners more broadly, where professional burnout and strategies to manage and prevent it have been studied for years. Support is not a comfort. It is a structural need.

Why Peer Support Works When Willpower Does Not

Therapists tend to be high achievers who believe the answer is more effort, better boundaries, or a more disciplined self-care routine. Those things help. They are also not enough on their own, because burnout is often relational and systemic rather than personal.

Research on the value of peer support points to gains that go beyond feeling better on a given day, including improvements in business growth, mental health, and overall sustainability. That combination matters for private practitioners, where emotional depletion and practice strain tend to move together.

Peer Supervision

Peer supervision and consultation groups give you a place to think out loud about a case before it becomes a knot in your stomach. They also give you something harder to find alone: calibration. When you hear a colleague describe the same countertransference, the same stuck case, the same second-guessing, the experience stops feeling like a personal shortcoming and starts looking like a shared occupational reality.

A Self-Care Buddy

For clinicians who carry negative beliefs about self-care, peer supervision or a self-care buddy can serve as an honest mirror. Someone who knows your caseload can notice what you are minimizing. “You have taken on three trauma cases this month” lands differently coming from a colleague than from a journal prompt or your own inner critic.

Structured Groups and Debriefing

Organizations that want burnout-resistant teams are building structured, trauma-informed support groups for supervisors and managers, plus training that prepares people to lead them. Crisis counselor teams are increasingly offered regular updates on trainings, peer support groups, and debriefing sessions. The message from the field is clear: peer support is not a bonus, it is infrastructure.

Practical Strategies You Can Start This Week

None of this requires a full practice overhaul. Small, repeated moves toward connection do more than one ambitious plan that never starts.

1. Name one colleague you could ask to be a check-in partner. Send the message before you have a perfect plan.
2. Set a monthly consultation group, even if it starts with two other clinicians and a video call.
3. Schedule a ten-minute debrief after your heaviest session of the week, with a peer or on your own with structured notes.
4. Review your caseload with someone else. You cannot see your own overexposure from inside it.
5. Protect one recovery block that does not involve a screen or a client-facing task.
6. Write down what actually drained you this week, then look for the pattern rather than the single bad day.
7. Look at how much isolation your practice design requires, and consider what could be shared instead.

Building a Network That Fits Your Practice

Many therapists work in settings with no built-in consultation, no team, and no one who understands the specific weight of running a private practice. Building support there takes intention, because the default is isolation.

TheraConnect grew out of the Fitness Hacks for Life mental wellness community and its 54,000+ members, which means the platform was shaped by people who already believed connection is part of the work, not a separate extra. Clients search the directory for free. Providers list their practices to reach people looking for a therapist by location, specialty, and session format, and the listing model was deliberately built to stay affordable rather than priced like a corporate directory.

Being listed is not a support group, and it is not a substitute for real relationship. It is one more place in your professional life where you are not invisible, and for many clinicians, that visibility is a meaningful first step toward community.

If you are carrying too much right now, the most useful thing you can do may be embarrassingly small. Send one text to one colleague. Ask for one hour of honest conversation. Take the first step at whatever pace you can manage, and let someone walk it with you.

Frequently Asked Questions

Is peer support the same as therapy for therapists?

Not exactly. Peer support is mutual and collegial, grounded in the shared experience of clinical work. Therapy is a formal treatment relationship where your clinician holds the expert role. Many therapists use both. Peer supervision and consultation groups help you process caseload stress and clinical decisions, while personal therapy addresses your own history and mental health. The two can complement each other.

How do I start a peer support group if I work alone?

Start smaller than feels impressive. Invite two or three clinicians you trust, agree on confidentiality and how often you will meet, and decide together whether the group is for consultation, personal support, or both. Rotate who facilitates. A simple structure of check-in, one case or theme, and a closing round keeps the group from drifting into a social hour that never quite happens.

How do I tell the difference between burnout and compassion fatigue?

Compassion fatigue describes the physical, emotional, and mental exhaustion that builds from repeated exposure to other people’s suffering, and it is common among mental health providers. Burnout is often framed more broadly around chronic occupational stress and depletion. In everyday practice the lines blur, and both respond best to support, reduced load, and honest reflection with peers rather than self-care alone.

Can peer support help my private practice, not just my mental health?

Yes. Understanding the value of peer support extends beyond morale. Connecting with peers can support business growth, mental health, and overall sustainability, which matters for clinicians who run their own practices and make every operational decision alone. Isolation is expensive, both emotionally and commercially, and regular peer contact is one of the simpler ways to reduce that cost.

What if I feel like I should be able to handle this on my own?

That belief is one of the most common barriers therapists face, and it is worth examining rather than obeying. More than half of therapists and counselors in one survey reported burnout in the past year, which means needing support is a normal professional experience, not evidence of incompetence. Try framing peer support as a routine part of clinical practice rather than a sign that something is wrong with you.

The quality of your relationships shapes your health as much as diet or exercise. In the Harvard Study of Adult Development, which has followed participants since 1938, relationship satisfaction at age 50 predicted health at 80 better than cholesterol levels did (Harvard Gazette). A review of 148 studies covering more than 300,000 people found that strong social relationships raised the odds of survival by about 50% (PLOS Medicine).

Yet relationships don’t come with a manual. Many of us repeat the same arguments, struggle to say what we need, or feel stuck after a breakup. Relationship coaching is one practical way to build the skills that make connection easier.

What is relationship coaching?

Relationship coaching is a forward-focused partnership that helps you build healthier relationships through clear goals, new skills and steady practice. The International Coaching Federation describes coaching as a “thought-provoking and creative process” that helps people reach their potential (ICF definition).

A relationship coach applies that approach to your connections. You might work with one on your own or as a couple. The focus is on where you are now, where you want to be, and the practical steps in between.

Relationship coach vs. couples therapist

Both can help, but they do different jobs. A coach builds skills for the future; a licensed therapist can also diagnose and treat mental health conditions and help you heal from the past.

If your relationship involves abuse, addiction, or symptoms of depression or anxiety, start with a licensed therapist. You can find a licensed therapist on TheraConnect. Many people see a therapist and a coach at different times, and that’s fine.

What a relationship coach can help with

• Communication: saying what you need without blame, and listening without getting defensive
• Conflict: breaking the cycle of the same argument and repairing after a fight
• Confidence and dating: knowing your values, spotting red flags and dating with intention
• Boundaries: with partners, family and friends
• Big transitions: moving in, getting engaged, becoming parents, or starting over after a breakup or divorce
• Reconnecting: bringing back closeness, fun and affection in a long-term relationship

Signs relationship coaching could help

• You keep having the same argument with no resolution.
• You feel more like roommates than partners.
• You repeat the same patterns in every relationship.
• You want to date again but feel unsure where to start.
• You’re facing a big decision together and want a clear plan.
• You and your partner are basically happy and want to keep it that way.

That last one matters. According to Dr. John Gottman, couples wait an average of six years of being unhappy before getting help (The Gottman Institute). Building skills early is easier than repairing years of hurt.

What to expect, and does it work?

Most coaching happens online or by phone in 45 to 60 minute sessions, weekly or every other week. A typical path looks like this:

1. First conversation: you share what’s going on and what you want to change.
2. Goals: together you set two or three specific goals.
3. Skills and practice: you learn tools, such as calm conflict scripts, and try them between sessions.
4. Check-ins: you review what worked and adjust.

Research on skills-based relationship programs is encouraging. A meta-analysis of 29 studies found that programs blending self-guided learning with face-to-face support produced meaningful gains in both relationship quality and communication skills (BYU ScholarsArchive). Coaching uses a similar mix of learning, practice and personal support. Results depend on effort from everyone involved, and coaching isn’t a substitute for therapy when deeper issues are present.

How to choose a relationship coach

• Training: ask about their coaching training and any certifications, such as ICF credentials.
• Specialty: look for experience with your situation, like dating, couples, divorce recovery or LGBTQ+ relationships.
• Approach: a good coach is respectful, nonjudgmental and focused on healthy, two-way relationships.
• Boundaries: they should know when to refer you to a licensed therapist.
• Fit: book a short intro call. You should feel heard and comfortable.
• Logistics: confirm price, session length, online or in-person, and cancellation policy up front.

Finding a relationship coach on TheraConnect

TheraConnect is a directory of therapists, counselors and coaches, built by the team behind the nonprofit FitnessHacksForLife.org. You can browse providers by specialty and location, compare their approaches, and choose a coach or a licensed therapist, depending on what you need. Signing up to connect is free for clients.

Are you a relationship coach? TheraConnect helps clients find you. Learn about joining as a provider.

Frequently asked questions

What does a relationship coach do?

A relationship coach helps individuals or couples set goals and build skills such as communication, conflict resolution, boundaries and dating confidence.

Is a relationship coach the same as a therapist?

No. Coaches focus on skills and goals. Licensed therapists can also diagnose and treat mental health conditions.

Can I see a relationship coach on my own?

Yes. Many clients are single, dating, or working on themselves while their partner isn’t involved.

Does relationship coaching work online?

Yes. Most coaches offer video or phone sessions, which makes it easy to fit into a busy schedule.

How much does relationship coaching cost?

Prices vary by coach, experience and session length. Ask for rates during a free or low-cost intro call.

When should I see a therapist instead?

If there is abuse, addiction, trauma, or ongoing depression or anxiety, start with a licensed therapist. In a crisis in the US, call or text 988.

Sources

1. Robert Waldinger on social fitness, Harvard Gazette (2023)
2. Holt-Lunstad, Smith and Layton, “Social Relationships and Mortality Risk: A Meta-analytic Review,” PLOS Medicine (2010)
3. ICF definition of coaching, UNT Health Science Center
4. “Timing Is Everything,” The Gottman Institute
5. “Examining the Early Evidence for Self-directed Marriage and Relationship Education: A Meta-analytic Study,” BYU ScholarsArchive

Burnout has a way of making every decision feel heavier than it should. You are tired in a way a weekend does not repair, work that once felt manageable now feels like a wall, and the idea of figuring out who to call adds one more task to an already full plate. Two very different kinds of professionals can help, and they do different things. Knowing which one fits your situation makes the search shorter and much less confusing.

What burnout is usually asking of you

Most people describe burnout as a combination of three things: exhaustion that rest does not touch, growing distance or cynicism toward work you used to care about, and a nagging sense that you are putting in more and getting back less. It builds slowly. It rarely comes from one bad week, and it rarely resolves from one good one.

What makes burnout tricky is that it does not have a single cause. Sometimes it is a workload problem. Sometimes it is a boundaries problem, a values problem, or a situation that echoes something older and harder. Because the roots differ, the right kind of support differs too. A coach and a therapist will each look at the same exhausted person and see a different path forward, and both paths can be legitimate.

What a coach offers when you are burned out

Life coaches specialize in helping equip you with the tools, motivation, and inspiration to maximize your personal and professional potential. Applied to burnout, that means a coach is often the right fit when the problem is mostly about direction, structure, and follow-through.

Life coaches are typically sought out to help with specific projects, goals, or transitions. In practice, a coach can help you:

• identify and create a vision for what you actually want your days to look like
• consider things from different alternatives and solve problems you feel stuck on
• build an individualized action plan you can realistically follow
• develop the tools, habits, and accountability to stay with that plan

If your burnout is tied to a role that no longer fits, a transition you have been avoiding, or a pattern of saying yes until there is nothing left for you, coaching can be a practical, forward-facing form of help. It tends to focus on what you will do next rather than on what happened before.

What a therapist offers when you are burned out

Therapy moves in a different direction. Therapists commonly list specialties that include complex trauma, depression, personality disorders, anxiety, grief, and relationship issues, and many describe their work as providing a safe, compassionate space to help you process your pain, reclaim your story, and finally feel safe in your own skin. Burnout often overlaps with those concerns, which is why the two kinds of help are not really competitors.

A therapist is usually the better choice when the exhaustion is tangled up with persistent low mood, anxiety that will not quiet down, grief, relationship strain, or a history you have never had room to work through. Therapy also makes sense when burnout has started affecting sleep, health, or your ability to function, or when the same pattern keeps repeating no matter how many plans you make.

The line coaches themselves worry about

The question keeps popping up for coaches at all levels: is this still coaching, and do I need to refer my client to a therapist? Do they really need therapy or counselling, or can I hold this space myself? Am I allowed to give advice? These are not signs of a weak coach. They are signs of a thoughtful one, and the training, experience, barriers to entry, goals, and outcomes of coaching and therapy genuinely differ.

A simple way to see the split:

Many people use both at once, and that is not a problem. Coaching keeps the practical side moving while therapy addresses the deeper material underneath.

How to choose without overthinking it

Ask yourself three plain questions. First, is my main problem about direction or about distress? Direction points toward coaching, distress toward therapy. Second, can I describe what I want in concrete terms, or does the feeling arrive before the words do? Third, has this been going on through several attempts to fix it on my own? Long-standing patterns are usually a therapy question.

If you are still unsure, a short introductory call settles more than a long comparison chart. Many providers offer a free initial call so you can hear how they work and ask directly whether your situation fits their scope. A good professional will tell you honestly if it does not.

Finding the right person through a directory

A directory search is often the fastest way to see who is actually available near you or online. TheraConnect connects clients with licensed mental health providers across the United States, and searching the directory is free for clients. You can filter by location, specialty, and session format, which matters when your energy is already low and you do not want to open fifteen browser tabs.

Provider listings can show verified licenses, sliding scale options, and telehealth availability, so you can check fit before you reach out. If you are a therapist or coach, listing your practice is a paid option, and the platform was built as a simpler, more human alternative to the larger directories, with roots in the Fitness Hacks for Life mental wellness community.

Questions worth asking on a first call

1. How do you usually work with someone showing signs of burnout?
2. Is my situation within your scope, or would you refer me elsewhere?
3. Do you offer sessions online, in person, or both?
4. Do you have sliding scale availability, and what does that process look like?
5. What would progress look like after the first few sessions?

Write the answers down. Burnout has a way of making you forget what you heard five minutes after you hang up.

If you are the coach on the other side of this

You do not have to hold everything. When a client’s material moves past goals and into trauma, depression, anxiety, grief, or relationship wounds, referring out is a professional act, not a failure. Keep a short list of trusted therapists in your area and online, be clear with clients about what you do and do not offer, and say plainly when therapy would serve them better. That honesty builds the kind of reputation a directory listing cannot buy.

Burnout recovery rarely happens in a straight line. The first step is simply deciding which kind of conversation you need next, and then having it with someone qualified to help.

Frequently Asked Questions

Can a coach help with burnout, or do I need a therapist?

A coach can help when burnout is mainly about goals, boundaries, workload structure, or a transition you are avoiding. Life coaches specialize in equipping you with tools, motivation, and an individualized action plan. A therapist is the better fit when exhaustion overlaps with depression, anxiety, grief, trauma, or relationship issues. Many people use both at the same time.

What is the difference between coaching and therapy?

They differ in training, experience, barriers to entry, goals, and outcomes. Coaching usually starts with a goal or transition and builds an action plan toward personal and professional potential. Therapy usually starts with distress and works through clinical concerns such as complex trauma, depression, anxiety, grief, and relationship issues in a safe therapeutic space. One is not a lesser version of the other.

What if my coach suggests I also see a therapist?

Take it as good practice rather than rejection. Coaches regularly ask themselves whether a situation is still coaching and whether a client should be referred to a therapist. A referral usually means your situation calls for training and scope your coach does not have. You can keep working with your coach on practical goals while seeing a therapist for the deeper material.

Does it cost anything to search TheraConnect as a client?

No. Searching the directory is free for clients. Therapists and coaches pay a low annual fee to list their practice, which is how the platform is funded. You can filter listings by location, specialty, and session format, and check for verified licenses, sliding scale options, and telehealth availability before you reach out to anyone.

How do I bring up burnout with a new provider?

Keep it concrete. Describe what your days actually look like, how long you have felt this way, and what you have already tried. Ask directly whether your situation fits their scope and what progress would look like. A short introductory call is often offered so you can test the fit before committing to ongoing sessions.

Your relationship feels stuck. Maybe conversations circle the same argument, or dating keeps ending the same way, or you keep noticing patterns you would rather not repeat. The hard part is figuring out who to call. Search results mix relationship coaches, couples counselors, dating therapists, and life coaches together, and the titles start to blur.

They are not the same job, even when the work overlaps. Understanding the difference helps you spend your time and money on support that actually matches what you need, and it makes the first conversation with a provider much easier to start.

What a Relationship Coach Does

Coaching tends to be forward focused and goal driven. Relationship and life coaching is often framed around clarifying your values, assessing what you want, and building strategies to reach your goals and strengthen your relationships. Sessions usually move toward an action plan rather than digging through old history.

Some coaching practices describe their relationship coaches as expert guides trained and supervised by licensed psychologists. That supervision matters when you are comparing options, because it tells you the coaches are accountable to a clinical standard even if they are not practicing as therapists themselves.

Coaching can suit a few common situations:

• You have a clear goal and want help building a plan to reach it.
• You feel unsure about your priorities and want a structured way to sort them out.
• You are dating and want practical feedback on patterns and choices.
• You want ongoing accountability and encouragement while you practice new skills.

Some providers offer a free consultation before you commit, which gives you a low pressure way to check fit. Availability varies, so ask about it directly rather than assuming.

What a Therapist Does

Therapy is clinical work, delivered by licensed mental health providers. It can address mental health conditions, relationship trauma, attachment patterns, anxiety, grief, burnout, and other concerns that affect how you show up with other people. A therapist is trained to assess what is happening, not just to coach you toward a goal.

Dating and relationship counseling can also be individual therapy focused on you, your patterns, your attachment style, and the relationship you are building with yourself. That framing is useful to keep in mind. You do not need to be part of a couple to work on relationship issues, and some people get more out of individual sessions before they try couples work.

Providers often hold different credentials. You may see psychotherapists, couples counselors, licensed mental health professionals, and drama therapists listed side by side, and some clinicians hold multiple roles such as therapist, dating coach, and couples counselor. Roles overlap, so read the credential line, not just the label.

Relationship Coaches vs. Therapists: Key Differences

The distinction is not about which professional is more caring. It is about scope, training, and what each type of work is designed to do. The table below reflects how these roles are generally described in provider materials, not a legal definition or a universal rule.

One more practical difference: therapists and coaches may both accept clients in the same city, which is why local searches turn up a mixed list. A provider directory can help you filter by the type of professional you actually want instead of guessing from a short bio.

How to Tell Which One You Need

Start with what is happening right now. If you can name a goal and describe what better would look like, coaching may be a reasonable first step. If you are dealing with distress that shows up across your life, a therapist is usually the more appropriate starting point.

Ask yourself a few honest questions:

1. Is this about a decision or a direction, or does it feel bigger than that?
2. Are you looking for skills and accountability, or support processing something painful?
3. Do you want to work on the relationship with a partner, or on your own patterns?
4. Is one person in the couple seeking help, or both?

If the answer points toward symptoms, trauma history, or a mental health concern, look for a licensed provider. If it points toward planning and motivation, coaching may fit. Many people use coaching first and move to therapy later, or the other way around, and that is normal.

Couples Work and the Online Option

Couples counseling online and in person is widely available. Some practices offer a free consultation before you start, and directories commonly list free initial calls so you can talk with a provider before booking a full session. These short calls exist so you can ask about approach, availability, and format without making a large commitment.

Online delivery has made this easier for people who are not near a big city or who work odd hours. A practice based in one place can offer online couples counseling, dating coaching, and support for social anxiety, which means your choice of provider no longer depends entirely on your zip code. If a provider offers both formats, ask which one they recommend for your situation.

Houston, Austin, Kansas City, San Francisco, and Boston all show active listings for relationship coaches and couples counselors, and online therapy directories now organize similar options anywhere in the country. The local search result is a starting point, not a limit.

Questions to Ask Before You Commit

A good intake conversation does more for your outcome than a perfect credential list. Ask direct questions and pay attention to how clearly the person answers.

• Are you a licensed therapist, a coach, or both, and what does your training look like?
• Do you work with couples, individuals, or both?
• How do you handle concerns that may be outside your scope?
• Do you offer a free consultation or a free initial call?
• Is supervision part of your practice?
• Have you worked with the specific issue I am bringing?

That last question carries weight. If dating keeps failing in the same way, ask about dating and relationship counseling experience. If you want help getting the most out of marriage counseling or relationship coaching, ask how the provider structures early sessions and keeps progress visible.

Red Flags and Scope Limits

Coaching should not pretend to be therapy. If a coach implies they can treat depression, anxiety, trauma, or a diagnosed condition, that is a reason to slow down and ask about their training and scope. Good coaches refer out when a situation calls for clinical care.

The reverse is also true. A therapist can help you reach goals, but treatment usually centers on health and functioning rather than a purely motivational agenda. If what you want is accountability between sessions, coaching models may fit better, and a therapist can still support you while you pursue it.

Nothing here replaces individual professional advice. If you are unsure which route is right, use a free consultation to ask directly, and verify credentials with the relevant licensing board in your state.

Using a Directory Without Getting Overwhelmed

A directory is only useful if it helps you narrow things down. Filter by the type of professional first, then by specialty, format, and availability. Read the bio line carefully to see if the provider is a coach, a therapist, or a clinician who offers coaching alongside treatment.

TheraConnect exists to make that search simpler and free for clients, connecting people with licensed providers across the United States by location, specialty, and session format, while providers pay a low annual fee to list. If you are ready to compare relationship coaches and therapists in one place, you can start with a single search and take the next step at a pace that feels right.

Frequently Asked Questions

Is a relationship coach the same as a therapist?

No. A relationship coach usually focuses on goals, values, and strategies, while a therapist is a licensed provider trained to assess and treat mental health concerns and relationship patterns. Some practices say their coaches are trained and supervised by licensed psychologists, and some clinicians hold both roles, so check each provider’s listing carefully before you book.

Can I do relationship coaching online?

Yes, online delivery is common for coaching and therapy alike. Many practices offer video sessions plus a free consultation, and directories list free initial calls so you can check fit before committing. Online access also means your search is not limited to your own city, which matters if local providers are booked or do not cover your issue.

Should I choose couples counseling or individual sessions?

It depends on where the problem lives. Couples work involves both partners, while dating and relationship counseling can be individual therapy focused on your own patterns, attachment style, and the relationship you build with yourself. If one partner will not attend, individual sessions can still be a productive starting point.

What should I ask on a free consultation?

Ask whether the provider is licensed, what training they have, whether supervision is part of their practice, and what issues they work with. Ask directly about format, availability, and whether couples or individuals are the better fit. A clear, specific answer tells you more than a long list of specialties on a profile.

How do I know if I need therapy instead of coaching?

If you are dealing with anxiety, trauma, grief, burnout, or distress that shows up across many areas of life, a licensed therapist is the safer starting point. If you can name a goal and want help building a plan, coaching may fit. When in doubt, ask a provider about scope and be ready to accept a referral.

Ella Fitzgerald sang that “into each life some rain must fall,” but it has felt like torrents of grief have fallen upon us in recent months. We all experience hardships and stress, and we are all very well-acquainted with that pit that forms in our stomach when nervousness takes hold. Many of us are feeling that pit as we process world and national news.

Demands from our personal and professional lives compete for our attention, and all too often the pressures of the day require more than we have to give.

Recent violence and tragedies such as police shootings in Dallas and Baton Rouge, the Nice truck killings and the attempted coup in Turkey seem to keep mounting. How do we deal with the resulting fear and anxiety? As a psychologist who has spent a great deal of my professional career studying the effects of trauma and grief, I have some knowledge of how to help people deal with the resulting anxiety.

Anxiety can turn debilitating

When the general public discusses the term “anxiety,” the usual meaning is one of unpleasantness related to having some arduous task that will require our resources at the expense of doing something that would bring us more enjoyment, such as sleeping late on the weekend, taking in a movie, or spending time with loved ones.

When the mental health community talks about anxiety, they are generally referring to a more disabling condition where a person’s individual ability to cope with stress becomes overwhelmed, leaving a person paralyzed and incapable of functioning effectively with life’s demands.

Where does this sense of anxiety come from? Is it more prevalent now, in the wake of so many tragedies before our eyes? Though the questions seem so simple, the answers may be extraordinarily difficult to uncover.

Nonstop news, with much of it bad

Certainly our world has changed with regard to the number of stressful situations to which we are exposed. With a 24-hour news cycle and a public that is hungry for graphic and sensational stories, it is increasingly difficult to shelter ourselves from disturbing news and images.

After 9/11, for example, it simply was not possible to escape the onslaught of information about the terrible events. For people who had little room left in their psychological resources to cope with hardship, 9/11 may very likely have placed them at risk for a full-blown anxiety attack.

The specific symptoms of anxiety vary from one person to the next, but the general pattern is a feeling of unease and worry, an inability to relax often accompanied by sleep disturbance, irritability and edginess. In more extreme examples of anxiety, panic attacks may result, characterized by feelings of racing heartbeat, shallow breathing, cold sweats and terror.

A pivotal study deepened our understanding of protective factors when it comes to life events and our ability to cope with anxiety.

The researchers identified three protective factors for individuals facing life adversity: individual factors, family factors and community factors. Individual factors include such things as personality variables, such as cheerfulness and friendliness. Family factors included having a close bond with at least one caregiver, as well as emotionally healthy environments that provided emotional encouragement and independence.

Community variables included things like supportive schools, churches and neighbors.

The research also found that even when youths are affected adversely by life events, most are able to right the proverbial ship by adulthood and live healthy, productive lives.

Weathering the storm

What then can individuals do to ward off the ill effects associated with anxiety? There is no one-size-fits-all approach. Consider the following ideas to get started with developing a stress-reduction plan:

• Give yourself a break. It is actually okay not be plugged in on the latest atrocity that has happened. If you find yourself reacting negatively to what you see on the news, give yourself permission to turn the television off.
• Plan ahead and keep things realistic. So much of anxiety has to do with ambiguity and uncertainty. Alleviate this by developing a game plan. For example, if your particular brand of anxiety seems to stem when considering finances, actually write down a household budget. You might surprise yourself by being able to come up with creative solutions when everything is laid out in front of you. Remind yourself that the world is generally a safe and friendly place, and don’t isolate yourself from connecting with family, friends and loved ones.
• Stay connected to others. Negative feelings can foster isolation, and isolated people lose the protective factors associated with community. Reach out to others and accept their help if they are willing and able to provide it.
• Keep things simple. Remember, one step at a time. When things get too big and unwieldy, they become unmanageable and seemingly impossible. Any progress is good progress, and focus on your successes when you have them.
• Plan for something fun. Give yourself permission to feel good and enjoy the things in life that make life worth living.
• Consult an expert. There may be people out there who can guide you even if things seem out of control right now. This includes mental health professionals who can help you to build coping resources and learn to relax and let go of the burdens of anxiety.

Unfortunately for all of us in today’s modern world, there’s no shortage of reasons to feel stressed or anxious. But at least there are some simple steps, founded in research, to help us.

Grief rarely follows a schedule. It can show up during a work meeting, on a quiet Sunday, or months after everyone else seems to expect you to be “better.” The best online grief counseling gives you a private place to speak honestly, without needing to commute, rearrange your whole week, or explain why your loss still hurts.

Online counseling is not about rushing grief toward a finish line. It is about finding a qualified professional who can help you make room for what happened, understand the changes in your life, and feel less alone while you move through them.

What Makes Online Grief Counseling a Good Fit?

Grief counseling can support people after the death of a loved one, but loss takes many forms. You may be grieving a relationship, a pregnancy, a job, your health, a pet, a future you expected, or the effects of a loved one’s illness. Your experience is personal, and you do not need to prove that it is serious enough to deserve support.

Virtual therapy can be especially helpful when grief has made everyday tasks feel heavier. You can meet from home, your office, or another private location. For some people, that familiar setting makes it easier to speak openly. For others, online sessions provide access to specialists who may not practice nearby.

Still, online care is not automatically the right choice for everyone. If you do not have a private place to talk, feel safer with face-to-face support, or need a higher level of care, in-person services may be a better fit. The goal is not to choose the most convenient option. It is to choose support that feels safe, appropriate, and sustainable.

How to Choose the Best Online Grief Counseling

The right counselor is not simply the person with the first available appointment. Grief is vulnerable territory. Take a little time to look for qualifications, relevant experience, and a communication style that helps you feel respected.

Start with licensure and professional credentials

Look for a licensed mental health professional who is authorized to provide therapy in the state where you are located. Depending on their training, their credentials may include licensed professional counselor, clinical social worker, marriage and family therapist, psychologist, or psychiatrist.

A therapist does not need a title that says “grief specialist” to provide meaningful grief support. However, it is reasonable to ask about their experience with bereavement, complicated grief, traumatic loss, caregiver loss, or the kind of loss you are facing. A qualified therapist should be able to explain how they approach this work in clear, compassionate language.

Consider the kind of loss and support you need

No two grief experiences look exactly alike. A person grieving a sudden death may need different support than someone who has spent years caring for a parent with a progressive illness. Someone mourning a partner may also be managing loneliness, financial stress, parenting responsibilities, or major changes in identity.

When reviewing therapist profiles or speaking during an initial consultation, consider whether the provider has experience with concerns connected to your loss. These might include anxiety, depression, trauma, family conflict, sleep disruption, guilt, anger, or life transitions. You do not need a perfect match on paper, but relevant experience can help a therapist understand the context without asking you to educate them every session.

Pay attention to the therapeutic relationship

Credentials matter, but connection matters too. You should not feel judged for crying, feeling numb, being angry, having complicated feelings about the person you lost, or struggling with beliefs other people expect you to have.

After a first session or consultation, ask yourself a few simple questions: Did I feel heard? Did this person seem present? Did they respect my pace? Can I imagine telling them the parts of this experience I usually keep to myself?

You may not feel instant relief. Therapy can bring up hard emotions before it brings clarity. But you should feel that the therapist is working with you, not directing your grief according to a rigid timeline.

Questions to Ask Before You Book

A brief conversation can help you decide whether a provider is likely to be a good fit. You can ask how often they typically meet with grieving clients, whether they have worked with a similar type of loss, and what a first few sessions may look like.

It can also help to ask practical questions. Confirm the session fee, whether the provider accepts your insurance or offers sliding-scale options, how long sessions last, and what their cancellation policy is. If affordability is a concern, bring it up early. Quality care should not require you to guess what you will be expected to pay.

Ask about availability, too. Grief may feel more manageable when appointments are consistent, so a therapist whose schedule works with yours can make a real difference. Evening or weekend availability may matter if you work full time, care for children, or support other family members.

Understanding Cost and Insurance

Online grief counseling costs vary based on the therapist’s credentials, location, session length, and payment approach. Some providers accept insurance, while others are private pay. If you plan to use insurance, check whether virtual mental health visits are covered and whether you need to meet a deductible first.

If you are paying out of pocket, ask directly about rates and reduced-fee options. Many people delay therapy because they assume it is out of reach, even when more affordable choices may be available. Transparent pricing is part of respectful care.

A matching platform can make the search less overwhelming by helping you compare therapists based on your preferences, budget, insurance needs, and availability. At TheraConnect, clients can get started for free and be matched with vetted providers who offer online support tailored to their needs.

What to Expect from Your First Online Session

You do not have to prepare a perfect story before your first appointment. You can begin wherever you are: “I do not know what to say,” “I have not been sleeping,” or “Everyone thinks I should be over this.” Those are valid places to start.

Your therapist may ask about your loss, your current support system, your daily functioning, and what you hope might feel different. They may also ask about your mental health history and any immediate safety concerns. This is not an interrogation. It helps them understand how to support you responsibly.

You are also allowed to set boundaries. If you are not ready to describe certain details, say so. If a question feels too fast, ask to slow down. Good grief counseling makes space for your consent, your culture, your beliefs, and your own relationship with the person or life chapter you lost.

When Grief Needs More Urgent Support

Grief can include intense sadness, anger, confusion, fatigue, and moments when life feels unreal. Those reactions can be painful and still fall within a broad human response to loss. But if you are having thoughts of harming yourself, feel unable to stay safe, or cannot manage basic daily needs, seek immediate help through emergency services, a local crisis resource, or someone you trust who can stay with you.

Therapy is a meaningful source of support, but it is not a substitute for emergency care. Reaching out in a crisis is not a burden to others. It is a protective step.

Finding a counselor will not erase what you have lost. What it can offer is a steady, confidential relationship where you do not have to carry every memory, question, and difficult day by yourself. Start with one small step: check your options, ask the questions that matter to you, and choose support that gives your grief the patience it deserves.

A quiet calendar, unanswered texts, and the feeling that no one truly knows what you are carrying can affect more than your mood. Loneliness and Health: How Connection Helps You Live Longer is not just a conversation about being social. It is about the role meaningful relationships can play in your mental, emotional, and physical well-being.

Loneliness is common, and it can happen even when you are surrounded by people. You may have coworkers, family members, or a busy social feed but still lack the sense of being understood, supported, or safe enough to be yourself. That gap matters.

How loneliness can affect your health

Research has consistently connected chronic loneliness and social isolation with poorer health outcomes. People who feel disconnected may be more likely to experience depression, anxiety, sleep problems, high stress, and unhealthy coping habits. Over time, ongoing stress can affect the body through changes in sleep, blood pressure, inflammation, and immune function.

This does not mean loneliness guarantees a health condition, or that a large friend group automatically protects someone from stress. Health is shaped by many factors, including medical history, income, work demands, caregiving responsibilities, and access to care. Still, connection is one protective factor that deserves attention.

A supportive relationship can help your nervous system settle. A conversation with someone who listens without judgment may make a difficult situation feel more manageable. Practical support matters, too: a friend who checks in, a family member who offers a ride, or a neighbor who notices when you have been having a hard week can reduce the feeling that you must handle everything alone.

Connection is about quality, not popularity

The goal is not to become more outgoing or fill every evening with plans. For many people, especially those who are introverted, grieving, living with anxiety, or adjusting to a major life change, a few dependable relationships can be more meaningful than a wide social circle.

Healthy connection usually includes mutuality. You can speak honestly, set boundaries, and feel respected even when you disagree. It might come from a close friend, partner, sibling, faith community, support group, colleague, or therapist. The right source of support depends on your needs and circumstances.

Online connection can help, particularly for people with mobility limitations, demanding schedules, or limited local resources. A video call with a trusted friend may be far more nourishing than scrolling through posts that leave you comparing your life to others. Digital spaces work best when they create real interaction rather than passive consumption.

Small ways to rebuild connection

When loneliness has lasted a long time, reaching out can feel risky. You may worry about burdening someone, being rejected, or having nothing worthwhile to say. Start smaller than you think you need to.

Send a simple message to one person: “I’ve been thinking of you. Want to catch up this week?” Return to a place where familiar faces gather, such as a class, volunteer shift, hobby group, or community event. If getting out feels like too much, schedule a brief phone call or ask someone to join you for a walk.

Consistency matters more than a single big effort. A standing weekly call, regular coffee break, or monthly game night gives relationships room to grow. It is also okay to notice when a relationship is one-sided or draining. Connection should not require you to ignore your own needs.

When coaching or therapy can help you reconnect

Sometimes loneliness is tied to experiences that are difficult to solve with a social plan alone. Depression can make people withdraw. Social anxiety can make invitations feel overwhelming. Trauma, grief, relationship conflict, and major transitions can all make closeness feel unsafe or out of reach.

Coaching and therapy offers a private, supportive place to explore what is behind the disconnection. A qualified mental care provider can help you identify patterns, practice communication skills, work through fears of rejection, and build strategies that fit your life. Therapy does not replace friendships or family relationships, but it can make it easier to create and sustain healthier ones.

For people seeking affordable, personalized virtual support, TheraConnect helps match clients with vetted mental health professionals based on individual needs and preferences. You do not have to wait until loneliness becomes unbearable to ask for help.

If you have been feeling disconnected, choose one gentle next step today. A message, a call, a walk with someone you trust, or a conversation with a therapist can be a meaningful reminder that support is available and that you deserve to feel connected.

Xue Zhang and Jonathan Wright

What comes to mind when you think about preventing teen suicide? Crisis hotlines, maybe. Emergency interventions. Those matter – but prevention often starts earlier, in everyday relationships at home, school and in the community. A parent asking about a teenager’s day over dinner, for instance. Or a teacher helping a student find purpose in what they’re learning. Or even neighbors cheering on teens at a Friday night game.

These moments may seem ordinary, but our research suggests they play a bigger role in protecting teens from suicide than most realize.

We are researchers from Penn State. One of us is a social epidemiologist who studies the social and structural determinants of health, and the other is a prevention scientist who studies risk and protective factors among young people.

Together, we analyzed data from more than 190,000 Pennsylvania adolescents who participated in the Pennsylvania Youth Survey. The survey was sent to students in grades 6-12 in 2023, capturing 52.3% of all eligible students in Pennsylvania. It is an anonymous survey administered every other year to assess students’ experiences with family, school and community, as well as mental health, substance use, violence and suicide risk.

We found that teens who felt connected to family, school and community – and were recognized for their positive behaviors – were less likely to report suicidal thoughts, plans, attempts and related injuries.

Suicidal thoughts are common among teens

Suicide is the third leading cause of death among American adolescents after accidents and homicide. Suicidal thoughts among teens are more widespread.

One great story in your inbox every afternoon

Try our Substack

In our study, 16% of the adolescents reported seriously considering suicide, 13% had made a suicide plan, 5% had attempted suicide, and 1% reported an attempt that resulted in an injury that required medical treatment.

Depression, substance use and being bullied are well-established risk factors for suicidal thoughts and behaviors. Our study confirmed that these experiences are strongly associated with greater suicide risk.

But what protects teens from suicide? To find out, we examined whether strong family, school and community relationships were linked to lower suicide risk.

Why relationships matter

Our analysis focused on two ideas. The first was social bonds, which is the feeling of being connected to family, committed to school and attached to one’s community. The second was social recognition, the feeling that positive behavior is noticed, appreciated and encouraged by parents, teachers, coaches or neighbors.

Social bonds and social recognition reflect whether adolescents feel that they belong and that they matter.

We found that teens who felt more connected to the people around them were less likely to report suicidal thoughts and behaviors, depression, being bullied and substance use. Family relationships showed the strongest protective effect, and school connectedness also served as a preventive measure. For example, teens who scored just one point higher on family attachment – feeling closer to their parents or caregivers, sharing their thoughts and feelings with them, doing fun things together, or feeling they could turn to them for help – were about 18% less likely to consider suicide than teens with low family attachment.

Rural teens generally faced higher suicide risk and reported fewer protective relationships overall. We found that rural teens had about a 15% higher probability of making a suicide plan and a 17% higher probability of attempting suicide than their urban peers. But they were also more likely to feel recognized and valued within their communities.

Small actions can have lasting effects

Our findings suggest that many opportunities for suicide prevention occur during ordinary daily interactions.

Families can make time for open and honest conversations with their teens, recognize teenagers’ efforts instead of focusing only on their achievements, and encouraging them to ask for help. These actions help teens feel supported and valued.

Schools play a central role in adolescents’ daily lives and their social and emotional development. They can strengthen a student’s sense of belonging by helping them build a relationship with at least one trusted teacher, creating opportunities for supportive friendships, and encouraging participation in clubs, sports and other activities. Schools also help cultivate social and emotional skills such as communication, empathy and problem-solving.

Data can help schools understand where to focus their prevention efforts. Many states collect statewide data on youth health and well-being, allowing schools and communities to track trends in teens’ health and better understand the protective factors in their communities. For example, the Pennsylvania Youth Survey, used in our study, includes an online data dashboard that helps schools identify strengths, recognize gaps and use local data to guide prevention efforts and evaluate their impact over time.

Communities also play an important role. When adults outside the family notice teens’ efforts, encourage them and recognize their positive contributions, they send an important message: You are seen and you matter. These connections can grow through sports teams, volunteer organizations, faith communities and neighborhood activities. They help adolescents feel that they belong to something larger than themselves.

Supportive relationships may be especially important in rural communities, where adolescents experience higher suicide rates while also facing greater barriers to mental health services, lower rates of screening and treatment, and greater availability to firearms.

We believe that expanding access to mental health care remains essential. But our findings suggest that families, schools and communities can also make a difference simply by creating everyday opportunities for young people to feel recognized, valued and connected. Responding quickly when a teenager is in crisis remains essential, but suicide prevention does not begin there. Prevention can be small interactions that build a sense of belonging and hope long before a crisis occurs.

If you or someone you know is struggling with thoughts of suicide, the 988 Suicide & Crisis Lifeline is available 24/7 by call or text, or via chat at 988lifeline.org.

Mention psychotherapy and many people picture a familiar movie scene: someone lying on a couch, talking about their childhood, while a therapist sits behind them taking notes.

That image comes largely from psychoanalysis. But it doesn’t represent most psychotherapy today. Psychotherapy and psychoanalysis aren’t really competing treatments.

Psychotherapy is the broader term for a range of psychological treatments designed to help people change troubling thoughts, feelings, behaviours, or relationships. These include cognitive behavioural therapy, family therapy, and psychoanalysis, which played an important role in the field’s development.

One great story in your inbox every afternoon

Try our Substack

Where did psychoanalysis come from?

Psychoanalysis developed from the work of Austrian neurologist Sigmund Freud in the late 19th and early 20th centuries.

Freud proposed that much of our mental life happens outside our conscious awareness. He believed early experiences and unconscious conflicts could shape how we feel and behave.

Psychoanalysis aimed to bring these influences into awareness. Patients were encouraged to say whatever came to mind, a technique known as free association, while the analyst helped them look for patterns and meanings. Dreams and the patient’s relationship with the analyst could also be explored.

Psychoanalysis also strongly influenced early psychotherapy with children. Freud famously worked with a five-year-old boy known as “Little Hans” for a phobia of horses. His daughter, Anna Freud, later became a pioneer of child psychoanalysis.

So, do you really lie on a couch?

In traditional psychoanalysis, quite possibly.

Traditional psychoanalysis is intensive. Patients may attend several sessions each week, often for years, typically lying on a couch with the analyst out of view.

In the early days of psychoanalysis, the analyst wasn’t necessarily silent. But rather than giving advice or teaching skills, they listened, asked questions, and offered interpretations intended to help the patient recognise patterns outside their awareness. Some psychoanalysts still practise this way.

But from the early 20th century, psychotherapy began to diversify. Behavioural therapies focused on learning and changing what people do. Later, cognitive therapies focused on changing patterns of thinking, while family therapies focused on interactions between people.

Meanwhile, modern psychodynamic therapy grew from psychoanalysis and retains some of its focus on unconscious processes and relationship patterns. But it is usually less intensive. Therapist and client generally sit face-to-face, meet less frequently, and the therapist may take a more active role.

What does psychotherapy look like today?

There’s no single answer because psychotherapy now includes many approaches. Many involve more than just talking.

A therapist might use carefully chosen questions to help someone examine a belief. For example, what evidence supports it? Is there another way of looking at the situation? They might then test that belief with a behavioural experiment in everyday life.

Someone who thinks, “If I speak at a meeting, I’ll make a fool of myself”, for example, might make a small contribution and observe how others respond – perhaps finding things don’t go as badly as they feared.

A therapist might help a person with depression plan activities that provide pleasure or a sense of achievement. Therapy may also involve practising new skills between sessions.

None of this involves mind-reading. Good psychotherapy should be collaborative: therapist and client agree on what they are trying to change and work together towards those goals.

What about children?

Psychotherapy doesn’t always involve an adult talking one-to-one with a therapist.

With children, the person doing much of the therapeutic work may sometimes be the parent.

Evidence-based parenting programs can help parents encourage positive behaviour, respond differently to problem behaviour and strengthen their relationship with their child. Other therapies involve both children and parents or use developmentally appropriate activities.

So, what happens in psychotherapy depends on who needs help and what problem they are experiencing.

But does psychotherapy work?

For many mental health problems, yes. But “psychotherapy” isn’t a single treatment. Asking whether psychotherapy works is a little like asking whether medicine works: which treatment, for which problem?

Some therapies have much stronger evidence for particular problems than others. The Australian Psychological Society’s ⁠Evidence-based Psychological Interventions review brings together research on psychological treatments for a range of mental health problems in adults, children, and adolescents.

So someone seeking help can ask not only, “Does therapy work?”, but “Which therapies have the best evidence for my problem?” They can also ask a psychologist what approach they use and how they’ll know if it’s working.

What about psychoanalysis? Research supports shorter psychodynamic therapies, which grew from the psychoanalytic tradition, for some mental health problems. But traditional, intensive psychoanalysis itself has been studied much less extensively.

So, what’s the difference?

The simplest answer is that psychotherapy is the umbrella, while psychoanalysis is one approach underneath it.

Psychoanalysis played a major role in psychotherapy’s history. But the field has changed enormously since Freud’s time.

Today, psychotherapy is unlikely to involve lying on a couch while someone silently analyses your unconscious mind. It’s much more likely to involve therapist and client agreeing on what needs to change and actively working together.