How long will I be in therapy?
Hi I’m Sarah! I’m a Manchester psychotherapist, working worldwide via Zoom.
I get asked this question a lot. You will often hear psychotherapists and counsellors say ‘how long is a piece of string’ or some such and I get it; not knowing how long you will need to invest in something can be frustrating and it can feel like people are being evasive by not giving a straight answer.
So I’m going to put together some information to help you understand what to consider in trying to figure out how long you’ll be in therapy.
Is the issue you are coming to therapy for a long term or a short term issue?
e.g. I’ve been depressed since I was 15 and I’m now 30. This is a long term issue and you’ve essentially had 15 years ‘practice’ at being depressed.
or I just lost my job and I feel depressed and demotivated. So this could be a short term issue as perhaps once you have a new job you will feel better and will have more structure.
The third option is that this is a long term issue that you think is a short term issue. So if you think you’re depressed because you’ve lost your job and you’re also depressed because you’re self critical and set unrealistic expectations for yourself then you may be dealing with a longer term issue that you anticipated.
Do you want to be in long term or short term therapy?
If you pay for your own therapy and you attend voluntarily, it’s up to you how long you want to be in therapy for. You should consider your:
Financial commitment - psychotherapy can be a big investment and it’s a good idea to think about how long you wish to pay or can afford to pay for therapy. There is also the factor of how much you priority you place on psychotherapy and how much difficulty your issues are causing you in relationships at work or with friends. It might also be a good idea to think about how much value you would place on the result you want, so how much value would you place on not feeling bad about yourself and what other benefits that would bring to your life.
If you would like to stay longer term in therapy it would be wise to pick a psychotherapist or counsellor whose fees you can afford on an ongoing basis.
Some psychotherapists or counsellors prefer to do long term work, some short term and some don’t mind. I normally work longer term which I would consider 1 year plus. This is because many of my clients grew up in difficult home environments or identify as having CPTSD (complex trauma or PTSD) and didn’t have the support they needed and the repair work can take a long time.
That said, I don’t mind short term work if people are clear about this when we speak and have realistic expectations of what short term work can achieve. You may not have time to go into events in depth and shorter term work might focus more on coping strategies than happened across thoughts that arise in more long term work.
If you aren’t sure, ask your prospective psychotherapist or counsellor how they work, if they are willing to work to your requirements and how long they envision working with you for.
Have you had any psychotherapy or counselling before?
I don’t think you can necessarily ‘skip forward’ in therapy but if you have seen a psychotherapist or counsellor before you might be able to bring these insights to your new therapist. People have different tolerances for discussions; some people find talking about feeling difficult or some people might be learning not to dissociate and to stay present in the initial phases of therapy without being to talk about what’s going on and this can come later.
What additional benefits are there in longer term psychotherapy?
I don’t think it’s always clear to clients why long term psychotherapy or counselling can have additional benefits so I think of it like layers.
1-2 months - clients will talk about their main issue in therapy. They may learn to identify where the problem originates. Topics in therapy are usually ‘big things’ and there might be an element of formality about what should/can be discussed.
Some clients finish here. You can always return to therapy at a later date (either with me or with someone else). It isn’t always the right time for therapy and you will need the space and a certain amount of energy to deal with what comes up. Some people discover that they are not ready to talk about things that had been long ignored. If I’m not the right therapist for you and I can think of someone that might be a better fit, then I’m happy to put you in touch with them or point you in the right direction.
3-6 months - We often dive into the important things quite quickly in sessions and therapy sessions can centre on topics that people don’t ordinarily discuss - self worth, suicidal thoughts, depression, panic attacks, existential issues but by time clients have been in therapy for a while they start to understand better what is useful for them to bring to therapy sessions. Hopefully they are now more comfortable with me and can start to go deeper into conversations and they are likely to censor themselves less as they realise that they are in a supportive environment and that I’m not judging them.
I would expect to see progress by now for anxiety, depression, panic attacks or better understanding CPTSD triggers or to be better able to cope with dissociation. Clients are always free to give me feedback on how they feel the therapy is progressing and what is helpful or not helpful to them.
6-12 months - We usually have a pretty good understanding of each other by this point. People might either start to bring up earlier events from their life which might not have felt ‘important’ enough to bring up sooner or they are more actively aware of their triggers and will have started to work on them before bringing them to therapy. So they might say ‘this happened at work and I think it has something to do with my mum, but I’m not sure exactly what’ and then we can start to fill in the gaps or work out whether what they’ve pieced together makes sense to them. My job is to know what to look for and bring up relevant patterns or repetitions that it can be quite difficult to spot in yourself.
1 year plus
Psychotherapy can provide ongoing support to people who haven’t had in in their family of origin, which includes clients with abusive, neglectful or emotionally neglectful (emotionally unavailable parents). Clients with CPTSD or complex trauma which is PTSD resulting from multiple instances of fear or disconnection are often in longer term therapy. Some therapists don’t agree that clients should stay in therapy for years. I believe that if someone benefits from and finds long term psychotherapy helpful then it is their choice as to how long to continue. We don’t tell people they visit the gym too frequently or that they shouldn’t get their hair cut regularly but some people view mental health as a short term issue ‘to be dealt with’ and moved on from. Some people need to work on their mental health regularly to feel well and if that’s you, I’m happy to support you in therapy as long as you would like to come. Clients at this stage often come twice a month for therapy although some continue to come weekly. I hope that if you haven’t had reliable people in your life by now that you have either found them or are actively looking for them as it’s important to have various forms of support available.
I hope this is helpful to understand why it can be difficult to answer the question ‘how long therapy takes’ but also provide some guidelines to give you an idea.
You can also read my blog post How long does therapy take for childhood trauma
If you’d like to work with me or find out if I can help you, please contact me for a free 20 minute phone consultation.