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    Mental health counseling in 2026: a crash course

    Mental health counseling, or psychotherapy, is talk-based treatment from licensed professionals such as psychiatrists, psychologists, counselors, social workers and family therapists.[1][2] Therapies such as CBT have strong trial evidence.[3] Access is still limited: as of September 2026 about 154.6 million Americans lived in federally designated mental health shortage areas.[4]

    Editor reviewedStrict sourcingUpdated ExplainerMental health, Health and medicine

    If you are in crisis: in the US, call or text 988 (Suicide & Crisis Lifeline). In the UK and Ireland, call Samaritans on 116 123. In other countries, find a local line at findahelpline.com.[5]

    Mental health counseling, also called psychotherapy or talk therapy, covers treatments that help people identify and change troubling emotions, thoughts and behaviours.[1] This crash course explains who provides it, what the evidence says, how to find and pay for it, and how the rules changed in 2025–2026. It covers mainly the US.

    This page is general information, not medical advice. Talk to a clinician about your own situation.

    Who provides therapy

    Many kinds of professionals offer therapy, including psychiatrists, psychologists, social workers, counselors and psychiatric nurses.[2]

    • Psychiatrists are medical doctors who diagnose and treat mental illness. They can prescribe medication.[6]
    • Psychologists usually have a doctorate (PhD or PsyD). They assess, diagnose and treat with psychotherapy.[7]
    • Counselors (LPC), clinical social workers (LCSW) and marriage and family therapists (LMFT) have master’s degrees, supervised clinical experience and a state license.[8][9][10]
    ProfessionTypical degreePrescribes?US jobs (BLS, 2025)Median pay (BLS, 2025)
    PsychiatristMD or DOYes[6]Not broken out hereNot broken out here
    Clinical/counseling psychologistPhD or PsyD[7]Only in some states[7]209,400 (all psychologists)[11]$99,110[12]
    Mental health counselor (LPC/LMHC)Master’s[8]No533,400 (incl. substance use counselors)[11]$59,350[12]
    Clinical social worker (LCSW)Master’s (MSW)[9]NoCounted with all social workers$61,780 (all social workers)[12]
    Marriage and family therapist (LMFT)Master’s[10]No76,300[11]$66,940[12]

    Licensing is set by each state. BLS projects counselor jobs to grow 18% from 2025 to 2035.[8][11]

    What the evidence says

    Psychotherapies do not go through FDA approval the way drugs do. Their evidence comes from clinical research.[13] Cognitive behavioral therapy is the most studied. A 2023 meta-analysis of 409 depression trials found moderate to large effects compared with care as usual or waitlists, but only a small and unstable advantage over other therapies.[3] Reviews also support dialectical behavior therapy (DBT) for borderline personality disorder, though on low-quality evidence. For PTSD, EMDR and trauma-focused CBT come out best.[14][15] See types of therapy for details.

    Finding and paying for care

    A primary care provider can screen and refer you. SAMHSA, insurers, state and county health departments, colleges and employer Employee Assistance Programs can also point you to care.[16] NIMH suggests asking about fees, insurance and sliding-scale rates before you start.[17] Paying with insurance can be harder for mental health care. In 2009–2010, only 55.3% of psychiatrists accepted new privately insured patients, compared with 88.7% of other physicians.[18] The practical guide covers the steps.

    The rules in 2025–2026

    • Parity. The federal parity law requires many health plans to cover mental health on terms comparable to medical care. A stricter 2024 rule is not being enforced in its new parts while it is reconsidered.[19][20] See mental-health-parity-law.
    • Shortages. HRSA counted 7,127 mental health shortage designations as of 30 September 2026. Most are based on the number of psychiatrists alone.[4][21]
    • Licenses across state lines. The Counseling Compact was live in ten states as of 1 October 2026.[22]
    • Telehealth. Medicare telehealth flexibilities run through 2027. Medicare’s in-person visit rule for mental health telehealth starts after 31 December 2027.[23][24]

    Follow ongoing changes in the access and regulation tracker.

    Online therapy and AI

    Guided internet CBT has performed about as well as face-to-face CBT in trials.[25] Online therapy companies have faced regulators, though. In privacy and billing cases, the FTC ordered BetterHelp to pay $7.8 million. Cerebral agreed to pay nearly $5.1 million in refunds plus a $2 million penalty.[26][27] AI chatbots are a separate, newer debate. As of November 2025, FDA had not authorised any generative-AI device for mental health conditions.[28] Read the online therapy explainer, the services guide and the AI chatbots analysis.

    For specific conditions, see major-depressive-disorder, generalized-anxiety-disorder, the depression treatments guide and the anxiety treatments guide.

    Next in the crash course

    More in Mental health

    Questions readers ask

    What is the difference between a psychiatrist and a psychologist?

    A psychiatrist is a medical doctor (MD or DO) who can prescribe medication. Clinical psychologists usually hold a PhD or PsyD and treat with psychotherapy; only some US states let them prescribe.[6][7]

    What do LPC, LCSW and LMFT mean?

    They are state licenses for master's-level clinicians. Licensed professional counselors (LPCs), licensed clinical social workers (LCSWs) and marriage and family therapists (LMFTs) all need a master's degree and supervised clinical experience, and counselors and family therapists must also pass a licensing exam.[8][9][10]

    Is therapy approved by the FDA like a drug?

    No. There is no formal FDA approval process for psychotherapies. Evidence comes from research, often trials involving many patients.[13]

    How many Americans live in a mental health shortage area?

    HRSA counted about 154.6 million people in 7,127 mental health shortage designations as of 30 September 2026. It estimates that 7,796 more practitioners would be needed to remove all of them.[4]

    What should I do in a mental health crisis?

    In the US, call or text 988. In the UK and Ireland, call Samaritans free on 116 123. Elsewhere, findahelpline.com lists local helplines.[5]

    Sources

    · 28 claims from 17 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      NIMH describes psychotherapy, or talk therapy, as a variety of treatments that help a person identify and change troubling emotions, thoughts and behaviours, usually one-on-one with a licensed professional or in a group. confirmedas of 2026-10-11

      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · What is psychotherapy? (retrieved 2026-10-11)
    2. [2]

      According to NIMH, many types of professionals offer psychotherapy, including psychiatrists, psychologists, social workers, counselors and psychiatric nurses. confirmedas of 2026-10-11

      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · How can I find a therapist? (retrieved 2026-10-11)
    3. [3]

      A 2023 meta-analysis of 409 trials (52,702 patients) found CBT for depression had moderate to large effects versus care as usual or waitlist (g=0.79), was only slightly and not robustly better than other psychotherapies, and matched medication in the short term. confirmedas of 2023-02-01

    4. [4]

      As of 30 September 2026, HRSA counted 7,127 mental health Health Professional Shortage Area designations covering about 154.6 million people, with 26.24% of need met and 7,796 more practitioners needed to remove every designation. confirmedas of 2026-09-30

    5. [5]

      In the US, people in suicidal crisis or emotional distress can call or text 988 to reach the 988 Suicide & Crisis Lifeline; in the UK and Ireland, Samaritans can be called free on 116 123; findahelpline.com lists helplines in other countries. confirmedas of 2026-10-11

    6. [6]

      Psychiatrists are medical doctors (MD or DO) who specialise in mental health; they diagnose and treat mental illness with psychotherapy, hospitalisation and medication, and can prescribe. confirmedas of 2026-10-11

    7. [7]

      Clinical and counseling psychologists typically hold a PhD or PsyD; they assess and diagnose mental disorders and treat them with psychotherapy, and some US states permit clinical psychologists to prescribe medication. confirmedas of 2026-10-11

    8. [8]

      Licensed counselors (such as LPCs) need a master's degree; BLS says all states require counselors in private practice to complete supervised clinical hours, pass an exam and do continuing education, with requirements varying by state. confirmedas of 2026-10-11

    9. [9]

      Clinical social workers (LCSWs) diagnose and treat mental, behavioural and emotional problems and need a master's degree, supervised clinical experience and a state license. confirmedas of 2026-10-11

    10. [10]

      All US states license marriage and family therapists, requiring a master's degree, a state-set number of hours of post-degree supervised clinical experience, a state-recognised exam and continuing education. confirmedas of 2026-10-11

    11. [11]

      BLS counted 533,400 substance abuse, behavioral disorder and mental health counselor jobs, 76,300 marriage and family therapist jobs and 209,400 psychologist jobs in 2025, and projects counselor jobs to grow 18% from 2025 to 2035. confirmedas of 2026-10-11

    12. [12]

      BLS reports 2025 median annual pay of $59,350 for mental health counselors, $66,940 for marriage and family therapists, $61,780 for social workers and $99,110 for psychologists. confirmedas of 2026-10-11

    13. [13]

      Unlike medicines, psychotherapies have no formal FDA approval process; NIMH says evidence of effectiveness comes from research involving large numbers of patients. confirmedas of 2026-10-11

      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · What are the elements of psychotherapy? (retrieved 2026-10-11)
    14. [14]

      A 2020 Cochrane review of 75 trials found therapies tailored to borderline personality disorder reduced symptom severity versus usual treatment; DBT, the most-studied approach, reduced severity and self-harm, but this evidence was rated low quality. confirmedas of 2020-05-04

    15. [15]

      A 2020 network meta-analysis of 90 trials (6,560 people) found EMDR and trauma-focused CBT appeared most effective at reducing PTSD symptoms in adults, with moderate-to-low quality evidence. confirmedas of 2020-02-17

    16. [16]

      NIMH lists routes to a provider including a primary care referral, SAMHSA's helpline and online locator, insurer directories, state and county health departments, college health centres and employer Employee Assistance Programs, which it describes as free and confidential. confirmedas of 2026-10-11

      • Help for Mental Illnesses · National Institute of Mental Health (NIH) · How can I find a health care provider or treatment? (retrieved 2026-10-11)
      • Help for Mental Illnesses · National Institute of Mental Health (NIH) · Employee assistance (retrieved 2026-10-11)
    17. [17]

      NIMH suggests asking a prospective therapist about credentials, approach and its evidence base, goals and expected number of sessions, whether they can prescribe medication, confidentiality, fees, insurance and sliding-scale fees. confirmedas of 2026-10-11

      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · How can I find a therapist? (retrieved 2026-10-11)
      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · What should I look for in a therapist? (retrieved 2026-10-11)
    18. [18]

      In a national survey for 2009–2010, 55.3% of psychiatrists accepted new patients with private insurance, compared with 88.7% of other physicians; acceptance of Medicare (54.8%) and Medicaid (43.1%) was also lower. confirmedas of 2014-02-01

    19. [19]

      On 9 September 2024 the Departments of Labor, HHS and the Treasury issued final MHPAEA rules, published on 23 September 2024, that bar plans from using non-quantitative treatment limitations that restrict mental health and substance use benefits more than medical/surgical benefits and require plans to collect and act on access data. confirmedas of 2024-09-23

    20. [20]

      On 15 May 2025 the three Departments said they would not enforce the parts of the 2024 rule that are new relative to the 2013 rule, for failures occurring before a final decision in the ERIC lawsuit plus 18 months, while they reconsider the rule, including possible rescission. confirmedas of 2025-05-15

    21. [21]

      HRSA says most mental health shortage designations are based only on the ratio of population to psychiatrists, so the "practitioners needed" figure largely counts psychiatrists. confirmedas of 2026-09-30

    22. [22]

      As of 1 October 2026 the Counseling Compact was live in ten states (Arizona, Arkansas, Georgia, Indiana, Louisiana, Minnesota, Ohio, Oklahoma, Tennessee and Wyoming), letting eligible licensed counselors who live there apply for a privilege to practise in the other nine. confirmedas of 2026-10-01

    23. [23]

      CMS says Medicare beneficiaries can receive telehealth anywhere in the US through 31 December 2027; from 1 January 2028, location limits return except for behavioural health services. confirmedas of 2026-10-08

    24. [24]

      CMS says Medicare's in-person visit requirement for mental health telehealth at home (a visit within 6 months before the first telehealth service, then every 12 months) takes effect after 31 December 2027, and people who start before then will count as established patients. confirmedas of 2026-10-08

    25. [25]

      A 2023 meta-analysis of 31 randomised trials across 16 conditions found therapist-supported internet CBT produced effects similar to face-to-face CBT (pooled g=0.02). confirmedas of 2023-06-01

    26. [26]

      In July 2023 the FTC finalised an order requiring BetterHelp to pay $7.8 million and banning it from sharing consumers' health data for advertising, resolving allegations that it shared sensitive data with Facebook, Snapchat and others after promising privacy. confirmedas of 2023-07-14

    27. [27]

      Under the FTC settlement Cerebral agreed to pay nearly $5.1 million for partial refunds over its cancellation practices and a $10 million civil penalty, suspended after a $2 million payment because of its inability to pay. confirmedas of 2024-04-15

    28. [28]

      At the November 2025 meeting, CDRH director Michelle Tarver said FDA had authorised more than 1,200 AI-enabled medical devices, but none yet used generative AI for mental health conditions. confirmedas of 2025-11-06

    Revision history (1)
    1. Page created.

    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Jan 11, 2027.

    Cite this page

    "Mental health counseling in 2026: a crash course." ContentLora, updated Oct 11, 2026. https://contentlora.com/explain/mental-health-counseling-explained

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