A growing number of American adults with mental health conditions are turning to psychotherapy, while reliance on psychiatric medications alone is showing a notable decline, according to a new study published in the American Journal of Psychiatry. The findings suggest a meaningful shift in how outpatient mental health care is delivered across the United States.
Dr. Mark Olfson, lead author of the study and professor of psychiatry and epidemiology at Columbia University, emphasized that this pattern indicates talk therapy is becoming a more central element in mental health care. “During this period, psychotherapy has taken on a larger role in outpatient treatment,” said Olfson. “The percentage of adults receiving therapy rose from approximately 6.5% in 2018 to 8.5% in 2021—an increase from around 16.5 million to nearly 22 million individuals.”
The trend represents a departure from past decades, when talk therapy had declined or plateaued, even as the use of medications like Prozac and other selective serotonin reuptake inhibitors (SSRIs) became more common in mental health care, starting in the late 1980s. For years, pharmacological interventions took precedence in outpatient treatment models.
But between 2018 and 2021, Olfson and his research team observed a shift. The share of adults receiving outpatient mental health care who relied solely on psychiatric medication dropped from 67.6% to 62.1%. Concurrently, those opting exclusively for talk therapy increased, particularly among individuals diagnosed with depression, anxiety, or disorders related to trauma and stress.
The study also noted that new therapy patients were attending more sessions annually, suggesting stronger engagement and possibly improved outcomes. “There’s evidence that therapy is becoming more accessible and that people are finding value in sticking with it,” Olfson added.
Psychiatrist Dr. Jessi Gold, chief wellness officer at the University of Tennessee System, views the development as a sign of growing public understanding of psychotherapy. “If people know what therapy entails, they may approach it with more realistic expectations, which helps them stay committed,” said Gold.
She added that although the trend predates the pandemic, COVID-19 contributed to greater openness around mental health and helped normalize discussions about seeking care. The expansion of telehealth services during that time played a significant role in improving access to therapy.
“Telehealth made a big difference for individuals who might not have had access due to geography or time constraints,” Gold said. “Access and awareness both grew.”
Another notable aspect of the study is the broadening profile of professionals offering therapy. In contrast to earlier years, when psychiatrists and psychologists provided the majority of talk therapy, licensed clinical social workers and professional counselors are now delivering much of this care. “The need for wider access has encouraged the adoption of diverse care models,” said Gold. “There’s now more flexibility in how and by whom therapy is provided, and that doesn’t always require a medical degree or doctorate.”
Despite these encouraging signs, the study also highlighted ongoing disparities in access. Olfson pointed out that those benefiting most from the increased availability of psychotherapy tend to be individuals with higher education levels, private insurance, and higher incomes—groups that often live in urban settings. “The gains are concentrated among the more privileged,” he noted.
He expressed hope that the study’s findings will prompt policies aimed at extending access to underserved populations. As of the most recent national survey conducted by the National Institute of Mental Health, only about 50% of U.S. adults with a mental illness had received treatment in the previous year.
