The future of psychotherapy

Norcross and colleagues have run Delphi polls of psychotherapy experts every decade since the 1980s. Their record is a useful corrective: panels consistently over-predict the growth of whatever is currently fashionable, and under-predict structural change in how care is delivered and funded.

Reasonably confident predictions

• Measurement-based care becomes standard rather than optional
• Continued growth of brief, structured and digitally delivered treatment, driven by cost and access
• Further erosion of the diagnostic system’s authority, with dimensional and process-based alternatives gaining ground
• Task-shifting to lay and non-specialist providers, following the global mental health evidence
• Integration and transdiagnostic protocols continuing to displace single-school training

Genuinely uncertain

• Large language models in mental health care: capable of plausible therapeutic conversation, with unresolved questions about safety in crisis, accountability, the meaning of a therapeutic relationship with a system that has no stake in the outcome, and the risk that access for the poor becomes software while access for the rich remains human
• Psychedelic-assisted therapies, where the regulatory position is unsettled and the methodology is contested
• Whether precision matching of patient to treatment will ever outperform allowing patients to choose
• Whether the field will address its WEIRD evidence base substantively or rhetorically