Psychotherapy

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PsychothPsychotherapy is one of the fundamental methods for treating mental disorders, including depression – a disease recognized by the World Health Organization as the leading cause of disability worldwide. In its simplest terms, it constitutes a set of structured psychological interventions whose common denominator is contact based on a therapeutic relationship. It is precisely this relationship – a safe, professional, and ethical form of cooperation – that distinguishes psychotherapy from purely medical interventions, such as pharmacotherapy.

Modern psychotherapy for depression is an interdisciplinary field rooted in medicine, clinical psychology, psychiatry, neuroscience, and social sciences. Its effectiveness has been confirmed by hundreds of randomized clinical trials and meta-analyses. Today, many forms of psychotherapy are included in the official recommendations of scientific societies – including NICE (United Kingdom), APA (USA), and PTPs (Poland) – as a first-line treatment or a treatment equivalent to pharmacotherapy for depressive disorders.

Important clinical information: Psychotherapy is a method of treatment, not a form of social conversation. Its correct implementation requires appropriate qualifications, certification from a scientific society, and supervision. This article serves as a source of educational information – the choice of treatment method should always be consulted with a psychiatrist or a certified psychotherapist.

What is psychotherapy? Definition and history

The term “psychotherapy” is derived from the Greek psyche (soul, mind) and therapeia (treatment, care). Although psychotherapy in common parlance is sometimes identified with the psychoanalysis of Sigmund Freud, its roots are much older. One of the earliest documented approaches to psychological interventions in medicine is attributed to the works of Ali ibn Sahl Rabban al-Tabari (838–870), who described the importance of psychological influences in the healing process in his Arabic medical encyclopedia, The Paradise of Wisdom.

Modern psychotherapy began to take shape at the turn of the 19th and 20th centuries. Freud and his students proposed a model based on the analysis of unconscious conflicts, defense mechanisms, and early relational experiences. Over time, psychoanalysis became the starting point for subsequent movements, leading to the creation of over 500 different approaches described in scientific literature. Key historical moments:

• 1952 – Hans Eysenck publishes a paper questioning the effectiveness of psychotherapy; the era of systematic empirical research begins.
• 1960s/70s – The birth of cognitive-behavioral therapy (Aaron Beck, Albert Ellis); a revolution in empirical psychiatry.
• 1977 – Smith and Glass conduct the first breakthrough meta-analysis of 375 studies; they demonstrate an effect size of d = 0.68 for psychotherapy vs. control.
• 1990s – The era of DSM-IV and the first lists of Empirically Supported Therapies (EST) by the APA; DBT (Linehan 1993), MBCT (Segal, Williams, Teasdale 2002), and ACT (Hayes) emerge.
• 2023–2024 – The Metapsy initiative (metapsy.org) publishes a series of living systematic reviews and the largest comparative meta-analyses in the history of psychotherapy.

Psychotherapy vs. psychosocial aid – a key distinction

In medical and clinical terms, it is necessary to distinguish psychotherapy sensu stricto from broadly understood psychosocial aid. This distinction is important for both patients and physicians referring patients for treatment.

Psychotherapy proper is a structured method of treatment conducted by an appropriately qualified therapist (holding scientific society certification and clinical supervision), based on a specific theory of psychopathology and mechanisms of change, with clearly defined therapeutic goals. It is particularly indicated for the treatment of affective disorders (depression, bipolar disorder), anxiety disorders, PTSD, eating disorders, personality disorders, and many other entities classified in ICD-11 and DSM-5.

Psychosocial aid includes activities supporting individuals without a diagnosed mental disorder who are experiencing a life crisis, adjustment stress, or relational difficulties. This may take the form of counseling, crisis intervention, psychoeducation, or coaching. It does not replace psychotherapy in the case of a diagnosed mental illness.

In Poland, psychotherapist qualifications are regulated by the Polish Psychiatric Association (PTP), the Polish Psychological Association (PTPs), and the Polish Council for Psychotherapy. Certification requires a minimum of 4 years of training at an accredited institute, personal therapy, and supervision. The act regulating the profession of psychotherapist in Poland is currently undergoing legislative work (as of 2026).

The psychotherapy market – economic data and trends 2024–2025

The global market for psychotherapeutic services and online psychiatry is growing at a double-digit rate. According to Coherent Market Insights, the global online therapy market value was approximately 9.68 billion USD in 2024 and is expected to reach 24.80 billion USD by 2031 at a CAGR of 14.4% [M1]. Data from Mordor Intelligence indicates a market value of 9.78 billion USD in 2025, with a projected growth to 27.14 billion USD by 2030 (CAGR 22.67%) [M2]. The telepsychiatry segment was valued at 22.9 billion USD in 2024, with a projected growth to 64.5 billion USD by 2030 (CAGR 18.4%) [M3].

Key driving factors: growing mental health awareness and destigmatization of psychiatric treatment; the expansion of telemedicine – the COVID-19 pandemic accelerated the adoption of telepsychiatry by approximately 150% in 2020; regulations providing reimbursement parity for online therapy; an increase in the prevalence of depression and anxiety disorders – OECD: +20% vs. pre-pandemic levels in 2022 [M4]. In 2025, cognitive-behavioral therapy (CBT) dominated the online segment with a share of approximately 48% [M2].

In Poland, the private psychotherapy market is estimated at several hundred million PLN annually. Public access to psychotherapy within the NFZ (National Health Fund) is very limited – waiting times for reimbursed therapy in many provinces range from 6 months to several years, which increases pressure on the private and digital sectors.

The burden of depression and the treatment gap – OECD and WHO data

Depression and anxiety disorders are the most common mental disorders in OECD countries. According to 2025 OECD data, approximately 3.4% of the population experiences full-blown major depression, and 19% of individuals in OECD and EU-27 countries exhibit mild to moderate depressive symptoms [1]. These disorders cause economic costs equal to more than 4.2% of GDP – with more than one-third of these costs being indirect costs: loss of productivity, sick leave, and presenteeism [2].

A key problem is the treatment gap: at least two-thirds of individuals with mental disorders do not receive any professional help [2]. In Poland, approximately 50–60% of patients with depression never reach a specialist. The COVID-19 pandemic increased the global prevalence of depression and anxiety by approximately 25%, and depression levels in 2022 remained at least 20% higher than before the pandemic [M4].

An OECD analysis from 2025 indicates that scaling four key interventions – including psychotherapeutic approaches – could prevent 26.2 million new cases of mental disorders in OECD countries between 2025 and 2050 [1]. Effective psychotherapy, including internet therapy and group interventions, has key potential in filling this therapeutic gap.

Goals of psychotherapy from a clinical perspective

The goals of psychotherapy are always formulated individually in the therapeutic contract; however, in general terms, they focus on a lasting change in the psychological functioning of the patient, rather than exclusively on temporary symptom relief. This perspective, oriented toward changing mechanisms, distinguishes psychotherapy from the pharmacological approach and constitutes its exceptional clinical value – particularly in relapse prevention.

Main goals of psychotherapy for depression:

• Reduction of depressive symptoms – low mood, anhedonia, retardation, suicidal thoughts
• Improvement of emotion regulation – identifying, tolerating, and modulating intense emotional states
• Modification of maladaptive cognitive schemas – changing ruminations, catastrophizing, polarized thinking (Beck’s triad)
• Increasing behavioral activity – breaking the vicious cycle of withdrawal and loss of positive reinforcements
• Improvement of interpersonal relations – key in the context of attachment theory and IPT approaches
• Growth in the sense of self-efficacy and self-esteem – long-term strengthening of psychological resilience
• Relapse prevention – recognizing early signals and developing coping skills

Neurobiological studies indicate that effective psychotherapy leads to measurable changes in brain functioning: normalization of amygdala activity, increased prefrontal cortex activity, and even epigenetic changes in genes regulating the HPA axis. DeRubeis et al. demonstrated that CBT and pharmacotherapy lead to changes in brain activity, however, in partially different areas – suggesting the complementarity of both treatment methods.

Effectiveness of psychotherapy in the light of research – meta-analyses 2020–2024

The scientific evidence base for the psychotherapy of depression is one of the richest in all of psychiatry. Professor Pim Cuijpers from Vrije Universiteit Amsterdam leads the Metapsy initiative (metapsy.org) – a living system of systematic reviews covering all published RCTs concerning psychotherapy for various mental disorders. Below are key results:

Review of 118 meta-analyses (Cuijpers et al., Journal of Affective Disorders, 2023)

A narrative review of 118 meta-analyses within Metapsy concerning psychotherapy for depression. Most important conclusions [3]:

• Most studies concern CBT, but many other approaches are equally effective – differences between schools are small
• Effective formats: individual, group, telephone, guided self-help
• The effects of psychotherapy are comparable to pharmacotherapy in the short term, but probably exceed it in the long term
• Combined treatment is more effective than either method alone

CBT Meta-analysis – 409 studies, 52,702 patients (Cuijpers et al., World Psychiatry, 2023)

The largest CBT meta-analysis in history. Key results [4]:

• CBT vs. control: g = 0.71 (95% CI: 0.62–0.79); after correction for publication bias and study quality: g = 0.53 (NNT = 2.6)
• CBT as an unguided self-help intervention: g = 0.45; in children and adolescents: g = 0.41
• CBT does not show a significant advantage over other psychotherapies – the equivalence effect
• CBT shows an advantage over pharmacotherapy in the long term

Absolute results – response and remission (Cuijpers et al., World Psychiatry, 2024)

Meta-analysis of 453 RCTs in 8 mental disorders. Results for major depression (MDD): response in psychotherapy 51.5% vs. 34.8% in the control group; remission 40.8% vs. 22.8% [5]. Psychotherapy is significantly effective, but still more than half of patients do not achieve a full response after one course of treatment – which highlights the need for sequencing strategies and combining methods.

Network meta-analysis of psychotherapy, pharmacotherapy, and combination (Cuijpers et al., World Psychiatry, 2020)

101 studies with 11,910 patients. Combined treatment was more effective than psychotherapy as monotherapy (RR = 1.27; 95% CI: 1.14–1.39) and pharmacotherapy as monotherapy (RR = 1.25; 95% CI: 1.14–1.37) [6]. Psychotherapy and pharmacotherapy were comparable in monotherapy.

Psychotherapy vs. pharmacotherapy – comparison and combined treatment

The question of whether it is better to treat depression with psychotherapy, medication, or both methods simultaneously is one of the most common questions asked by patients and their families. The current state of scientific knowledge allows for the following conclusions:

In mild to moderate depression: psychotherapy (particularly CBT, IPT, behavioral activation) is an equivalent first-line method to pharmacotherapy. A 2024 eClinicalMedicine meta-analysis (676 RCTs, 105,477 patients) showed that in mild depression, psychotherapy, yoga, and self-help were effective and did not yield to antidepressants [7]. NICE guidelines (2022) recommend psychotherapy as the first intervention in mild to moderate depression.

In moderate to severe depression: combined treatment (psychotherapy + antidepressant) gives the best clinical results – approximately 25–27% higher probability of response vs. monotherapy [6]. PTPs and PTP guidelines recommend this strategy as the standard for HAM-D severity ≥ 20 or when monotherapy is ineffective.

Key mechanistic difference: medications work faster (effect after 2–4 weeks), but require continuous use and are associated with a risk of relapse after discontinuation. Psychotherapy requires more time, but its effects persist longer after treatment ends.

Clinical conclusion: The choice between psychotherapy and pharmacotherapy does not have to be an alternative. In moderate to severe depression, combined treatment is the evidence-based standard. In mild depression, patient preferences, therapist availability, and symptom profile should guide the therapeutic decision.

Relapse prevention in depression – lasting effects of psychotherapy

One of the greatest clinical advantages of psychotherapy over pharmacotherapy is its lasting effect after treatment ends. Depression is a relapsing disease: approximately 50% of patients experience a relapse after the first episode, and with two or more episodes, the relapse rate exceeds 70–80%.

A meta-analysis by Zhou et al. (Translational Psychiatry, 2023) – 25 RCTs, 2871 patients – analyzes the effectiveness of psychological interventions in preventing depression relapse [8]:

• MBCT shows a continuous effect of relapse prevention up to 9 months of observation; reduction of relapse risk by 40–50% in patients with ≥3 episodes of depression
• CBT shows a long-lasting effect up to 21–24 months of observation
• Behavioral activation and IPT show a late but significant effect from approximately 21–24 months
• All studied psychological interventions were significantly more effective than counseling support

For comparison with pharmacotherapy: after CBT, the relapse rate within one year is approximately 29%, after two years approximately 54% [9]. After discontinuing antidepressants (medication vs. placebo), the relapse rate in the first year reaches approximately 60%. Barton et al. (Frontiers in Psychiatry, 2024) confirmed that psychotherapy shows a long-term advantage over pharmacotherapy after the end of treatment [10].

Major psychotherapeutic schools

Modern psychotherapy includes several hundred schools and theoretical approaches. For clinical and educational purposes, several main schools are distinguished, differing in their understanding of the sources of psychological suffering and the mechanisms of therapeutic change. However, in clinical practice, they often exhibit comparable effectiveness – a phenomenon known as the Dodo bird verdict (Luborsky 1975): “Everyone has won and all must have prizes.” This means that differences in effectiveness between schools are generally small, whereas common factors – the quality of the therapeutic alliance, empathy, positive expectations – play a key role in each of them.

Cognitive-behavioral therapy (CBT) in depression

Cognitive-behavioral therapy is the best-studied form of psychotherapy for depression and anxiety disorders. Developed by Aaron Beck in the 1960s, it is based on a model in which emotional disorders result from maladaptive patterns of thinking (negative automatic thoughts, core beliefs, Beck’s depressive triad: negative image of self, the world, and the future) and patterns of behavior (withdrawal, avoidance, loss of positive reinforcements).

A standard CBT course for depression includes 12–20 individual sessions (45–60 minutes each) over 3–5 months. The session structure is standardized: a common agenda, working with automatic thoughts (thought records, cognitive restructuring), behavioral experiments, behavioral activation, and homework. CBT protocols for depression have been translated and validated in many cultures, including Polish.

Key scientific evidence for CBT in depression [4]:

• Effect size g = 0.53–0.71 (NNT = 2.6) compared to the control group
• Effectiveness demonstrated in individual, group, telephone, and online formats
• No significant advantage of CBT over other psychotherapies – the equivalence effect
• CBT advantage over pharmacotherapy in the long term (lower relapse rate)

Behavioral activation (BA) is a simplified and equally effective version of CBT, focused exclusively on increasing activity and contact with natural positive reinforcements. Meta-analyses have shown that BA is as effective as the full CBT protocol with lower therapist training costs – which has important implications for public health.

Psychodynamic psychotherapy and psychoanalytic therapy

Psychodynamic psychotherapy is derived from Freud’s psychoanalysis but has evolved significantly – becoming a more flexible, interactive, and empirically verifiable approach. Its modern forms (short-term psychodynamic therapy – STPP, object relations therapy, transference-focused therapy – TFP, dynamic interpersonal therapy – DIT) combine classic elements with attachment theory and affective neuroscience.

Key concepts: the role of unconscious conflicts and defenses in generating symptoms; relational patterns derived from early experiences (CCRT model – central relationship conflictual theme); the significance of the therapeutic relationship as a “corrective emotional experience”; analysis of transference and countertransference.

Empirical evidence: a meta-analysis by Shedler (American Psychologist, 2010) demonstrates an effect size of d = 0.97 for psychodynamic psychotherapy vs. control – comparable to CBT [11]. An RCT study (BMC Psychiatry, 2025) comparing CBT and STPP demonstrated comparable effectiveness of both approaches in MDD – without significant differences in remission and response [12]. Dynamic interpersonal therapy (DIT) in an RCT study (2025) demonstrated lasting, multidimensional benefits in MDD, surpassing CBT and pharmacotherapy in terms of maintaining improvement in mood, sleep, and cognitive functions [13].

Long-term psychodynamic psychotherapy (LTPP) is particularly indicated in: depression with deep personality disorders, recurrent depression with clear relational patterns as triggers, and when short-term treatment was ineffective.

Third wave of CBT: MBCT, ACT, DBT, and schema therapy

“Third wave” CBT therapies took shape in the 1990s as an evolution of classic CBT. Instead of focusing on changing the content of thoughts and beliefs, they focus on changing the person’s relationship with their own thoughts and emotions – acceptance, mindfulness, psychological flexibility, and life values.

A network meta-analysis by Schefft et al. (Frontiers in Psychiatry, 2023) – effectiveness of third-wave therapies in depression [14]:

• All third-wave therapies except DBT and ST were significantly more effective than the waiting list and standard treatment; effect sizes: 0.78–1.99
• No third-wave therapy differed significantly from CBT in terms of effectiveness
• MCT (metacognitive therapy) demonstrated higher effectiveness than MBCT, DBT, and CBASP in direct comparisons

MBCT – Mindfulness-Based Cognitive Therapy

MBCT (Segal, Williams, and Teasdale 2002) combines CBT with mindfulness training. Originally designed to prevent depression relapse in individuals with at least 3 previous episodes. Relapse risk reduction of 40–50% in these patients compared to standard treatment [8]. MBCT is recommended by NICE as a treatment to prevent the relapse of recurrent depression. The program lasts 8 weeks – weekly 2-hour group sessions.

ACT – Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (Hayes, Wilson, Strosahl 1999) focuses on the acceptance of difficult experiences, cognitive defusion, contact with the present moment, clarification of life values, and committed action. Meta-analysis shows a moderate effect (d = 0.68) for ACT in mental disorders. In depression, ACT is effective and comparable to CBT [14]. Particularly useful for chronic pain co-occurring with depression.

DBT – Dialectical Behavior Therapy

Dialectical Behavior Therapy (Linehan 1993) combines strategies of acceptance (mindfulness, validation) and change (classic CBT techniques). In depression, it is used mainly when borderline personality disorder co-exists or in the case of suicidal/self-harming tendencies. The full DBT program includes 4 skill modules: emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. More on the page behavioral psychotherapy.

Schema therapy (ST)

Developed by Jeffrey Young as an extension of CBT for hard-to-treat problems – personality disorders and chronic depression. It identifies early childhood maladaptive schemas and works with them through cognitive, behavioral, and experiential techniques (imagery rescripting, chair dialogue, mode work). Certification by ISST.

Humanistic-existential and systemic approaches

The humanistic-existential approach emphasizes the patient’s subjective experience, their needs, values, and pursuit of self-realization. Carl Rogers (1902–1987) formulated the necessary and sufficient conditions for therapeutic change: unconditional acceptance, empathy, and therapist authenticity. Research on common factors – including Wampold’s work – indicates that the quality of the therapeutic alliance explains approximately 7–15% of the variance in results, regardless of the method used [15].

The humanistic school includes: person-centered therapy (PCT), existential therapy (Yalom), Gestalt therapy focused on the “here and now” experience, psychodrama (Moreno), and Ericksonian psychotherapy with elements of hypnosis.

The systemic approach views psychological difficulties in the context of family and social relations. It includes family therapy (Minuchin, Haley), marital/partner therapy, the narrative approach (White, Epston), and solution-focused therapy (SFBT). In the case of children and adolescents with depression, family therapy is often a key complement to individual work with the young patient.

Organizational forms of psychotherapy

Individual psychotherapy – the most common form. It provides privacy and deep exploration of individual problems. Particularly indicated in depression with trauma, personality disorders, or when the patient needs an intense therapeutic relationship.

Group psychotherapy provides unique opportunities for interpersonal work. Curative factors in a group according to Yalom: instillation of hope, sense of universality of suffering, mutual learning, altruism, corrective recapitulation of family behaviors, development of social skills, catharsis. Effectiveness in depression g ≈ 0.60–0.70; significantly more cost-effective than individual therapy.

Couples and marital therapy (EFT – Emotionally Focused Couple Therapy, IBCT, CBT for couples) is indicated when depression is linked to conflicts in the relationship. Relational dysfunction is both a risk factor and a factor sustaining depression.

Family therapy is particularly important in depression among children and adolescents. NICE recommends family therapy as the first line of treatment for depression in adolescents in the case of clear family problems.

Duration: short-term therapies (8–20 sessions) focus on a specific problem; long-term therapies (>2 years) aim at a deeper change in the personality structure.

Online psychotherapy – effectiveness and prospects

Online therapy (e-therapy, telepsychiatry, iCBT) is one of the most dynamically developing areas of psychological help. The COVID-19 pandemic accelerated the adoption of remote therapy. In the USA in 2021, 81% of psychiatrists conducted 75–100% of visits via telephone or video. The online therapy market reached over 9.6 billion USD in 2024 with a CAGR of approximately 14–23% [M1, M2].

Key conclusions regarding the effectiveness of online therapy:

• iCBT meta-analyses: effect size comparable to face-to-face therapy (g ≈ 0.58–0.78) for depression and anxiety disorders
• Video therapy is closer to standard personal therapy than self-help applications
• Guided self-help is significantly more effective than self-help without support
• Particularly effective in mild and moderate depression, anxiety disorders, and insomnia

Limitations: difficulties in building a therapeutic alliance with some patients; lack of full body language assessment; inappropriate for patients in deep psychotic depression, in active suicidal crisis, or with complex personality disorders. Regulations in Poland: Ethical Code of the Polish Psychological Association and RODO (GDPR) requirements.

Neurobiological foundations of psychotherapy

Modern neuroscience provides evidence that effective psychotherapy leads to measurable changes in the structure and function of the brain. This is an important argument against the “medication vs. therapy” dichotomy – both methods work at the biological level, but through different mechanisms.

Key neurobiological discoveries:

• Normalization of amygdala activity: Amygdala hyperactivity in depression normalizes after effective CBT. fMRI studies demonstrate a reduction in the amygdala’s response to emotional stimuli after CBT – similar to that observed after pharmacotherapy, although in partially different circuits.
• Increased prefrontal cortex (PFC) activity: CBT and other psychotherapies increase activity in the dorsolateral PFC responsible for emotional control and mood regulation.
• Hippocampal neuroplasticity: Psychotherapy is associated with an increase in BDNF concentration and neurogenesis in the hippocampus – similar to that observed after antidepressants.
• Regulation of the HPA axis: Psychotherapy – particularly CBT and mindfulness-based therapies – normalizes the hyperactivity of the hypothalamus-pituitary-adrenal axis and lowers cortisol concentration.
• Epigenetic changes: Preliminary studies suggest that psychotherapy can lead to changes in DNA methylation in genes regulating the HPA axis (NR3C1, FK506BP5), which may explain long-term protective effects against relapse.

For whom is psychotherapy? Indications and specific populations

Indications for psychotherapy in depression:

• Mild to moderate depression (as monotherapy or in combination)
• Recurrent depression with clear psychological or relational factors
• Depression with accompanying anxiety disorders, PTSD, OCD
• Depression in the course of personality disorders (particularly borderline, narcissistic, dependent)
• Postpartum depression (independently or in combination)
• Difficulties in accepting or tolerating antidepressant medications
• Relapse prevention after pharmacological remission (particularly MBCT)
• Patient preferences regarding non-drug methods

Specific populations: Children and adolescents – CBT, family therapy, and IPT show documented effectiveness; effects are smaller than in adults (g = 0.41). Seniors – psychotherapy is effective and recommended; it requires adaptation of pace and consideration of somatic diseases. Postpartum depression – CBT, IPT, and interpersonal therapy are effective; couples therapy may be an important supplement. Depression with chronic pain – ACT and pain-oriented CBT demonstrate particular effectiveness.

Situations requiring special caution: Deep psychotic depression – requires pharmacotherapy before intensive psychotherapy. Active suicidal ideation – requires safety assessment; DBT can be conducted in parallel with psychiatric treatment. Bipolar depression – psychotherapy (psychoeducation, IPSRT, FFT) is an important supplement but cannot replace mood-stabilizing medications.

How to choose a psychotherapist and form of therapy?

Choosing the right therapist and method of work is one of the most important decisions in the process of treating depression. Research on common factors indicates that the quality of the therapeutic alliance is one of the strongest predictors of the therapy’s effect – more important than the specific method [15].

Qualifications and certification: A certified psychotherapist in Poland should possess full training (minimum 4 years) at an accredited institute, documented supervision, and membership in a scientific society (PTP, PTPs, Polish Council for Psychotherapy). It is worth asking about the school of work and experience in treating depression.

Matching the method to the problem: In depression, CBT, IPT, short-term psychodynamic psychotherapy, and behavioral activation are well-documented. In recurrent depression with trauma or personality disorders, it is worth considering longer psychodynamic therapy or schema therapy. For relapse prevention – MBCT.

First meeting as verification: The first 1–3 sessions are a stage of diagnosis and mutual acquaintance. A good therapist discusses the therapeutic contract, formulates the goal of the work, and answers questions regarding the method. A sense of safety, understanding, and professionalism from the therapist is key.

Red flags: No improvement after 8–12 sessions without reflection on changing the approach; no discussion of the contract and goals of therapy; violation of professional boundaries; lack of supervision; promises of quick effects without an empirical basis.

How to find a psychotherapist in Poland? Databases of certified psychotherapists are available on the websites: psychiatria.pl (PTP), ptp.org.pl (PTPs), psychoterapia-ptp.pl (Polish Council for Psychotherapy). Psychotherapy is reimbursed by the NFZ in mental health clinics (waiting times can be long), and a private session usually costs 150–350 PLN.

Summary table: comparison of psychotherapy schools in depression

School / Method	Main Assumption	Duration	Main Indications in Depression	Scientific Evidence
CBT	Maladaptive patterns of thinking and behavior	12–20 sessions	MDD, anxiety, PTSD, OCD, SAD	g = 0.53–0.71 [4]
Behavioral activation (BA)	Withdrawal and loss of reinforcement as a depression mechanism	8–16 sessions	MDD, vascular depression, geriatrics	Comparable to CBT [4, 14]
IPT (interpersonal therapy)	Depression as a reaction to interpersonal problems	12–16 sessions	MDD, postpartum depression, seniors	Effect comparable to CBT [3, 6]
MBCT	Mindfulness as an antidote to ruminations and depressive reactivity	8-week group course	Relapse prevention (≥3 episodes)	Relapse risk reduction by 40–50% [8]
ACT	Avoiding experiences as the core of suffering; values and commitment	16–20 sessions	MDD, depression with chronic pain	d = 0.68; comparable to CBT [14]
DBT	Dialectics of acceptance and change; emotion regulation	12–24 months	Depression + BPD, self-harm, suicidality	Moderate effectiveness in MDD [14]
MCT	Rumination as a dysfunctional metacognitive strategy	8–12 sessions	Depression with rumination, GAD	Highest effectiveness in third-wave NMA [14]
Psychodynamic psychotherapy	Unconscious conflicts and relational patterns	16–30 sessions or 2–5 years (LTPP)	MDD with personality disorders, post-trauma depression	d = 0.97 [11]; RCT comparable to CBT [12, 13]
Schema therapy (ST)	Early childhood maladaptive schemas	1–4 years	Chronic depression, personality disorders	Promising – growing base [14]
Humanistic / Gestalt / Ericksonian	Self-realization, “here and now” experience, client resources	Variable	Adaptive depression, work with identity	Smaller RCT base; common factors [15]
Systemic / Family	Depression as a symptom in the family system	10–24 sessions	Depression in children/adolescents, relational conflicts	Effective in specific groups [3]

Bibliography and scientific sources

1. [1] OECD (2025). Mental Health Promotion and Prevention: Best Practices in Public Health. OECD Publishing, Paris. https://doi.org/10.1787/88bbe914-en
2. [2] OECD (2021). A New Benchmark for Mental Health Systems. OECD Publishing, Paris. https://www.oecd.org/en/publications/a-new-benchmark-for-mental-health-systems
3. [3] Cuijpers P. et al. (2023). Psychological treatment of depression: A systematic overview of a Meta-Analytic Research Domain. Journal of Affective Disorders, 335, 141–151. https://doi.org/10.1016/j.jad.2023.05.011
4. [4] Cuijpers P. et al. (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. https://doi.org/10.1002/wps.21069
5. [5] Cuijpers P. et al. (2024). Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis. World Psychiatry, 23(2). https://doi.org/10.1002/wps.21203
6. [6] Cuijpers P. et al. (2020). A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92–107. https://doi.org/10.1002/wps.20701
7. [7] Weitz E.S. et al. (2024). Network meta-analysis of psychological, pharmacological and combination treatments for depression. eClinicalMedicine.
8. [8] Zhou Y. et al. (2023). Psychological interventions for the prevention of depression relapse: systematic review and network meta-analysis. Translational Psychiatry, 13(1), 300. https://doi.org/10.1038/s41398-023-02604-1
9. [9] Vittengl J.R. et al. (2007). Reducing relapse and recurrence in unipolar depression: a comparative meta-analysis of CBT effects. Journal of Consulting and Clinical Psychology, 75(3), 475–488.
10. [10] Barton B.B. et al. (2024). Enduring effects of psychotherapy, antidepressants and their combination for depression: systematic review and meta-analysis. Frontiers in Psychiatry, 15, 1415905. https://doi.org/10.3389/fpsyt.2024.1415905
11. [11] Shedler J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378
12. [12] Comparative effectiveness of CBT and STPP for major depression in psychiatric outpatient clinics: a randomized controlled trial. BMC Psychiatry, 2025. https://doi.org/10.1186/s12888-025-06544-6
13. [13] Advancing depression treatment: DIT versus CBT and pharmacotherapy on symptoms, sleep, and cognition. ScienceDirect, 2025. https://doi.org/10.1016/j.jad.2025
14. [14] Schefft C. et al. (2023). Efficacy and acceptability of third-wave psychotherapies in the treatment of depression: a network meta-analysis. Frontiers in Psychiatry, 14, 1189970. https://doi.org/10.3389/fpsyt.2023.1189970
15. [15] Wampold B.E., Imel Z.E. (2015). The Great Psychotherapy Debate (2nd ed.). Routledge. ISBN 978-1138827378
16. [M1] Coherent Market Insights (2024). Online Therapy Services Market to Reach US$ 24.80 Billion by 2031. BioSpace.
17. [M2] Mordor Intelligence (2025). Online Therapy Service Market 2025–2030. https://www.mordorintelligence.com
18. [M3] Grand View Research (2025). Telepsychiatry Market Size, Share and Trends. https://www.grandviewresearch.com
19. [M4] OECD (2025). Mental health. https://www.oecd.org/en/topics/sub-issues/mental-health.html
20. [M5] SNS Insider / GlobeNewswire (2026). Online Therapy Services Market Projected to Surpass USD 17.34 Billion by 2035. https://www.globenewswire.com