Sometimes Therapy Just Takes A While, Even If You're Doing Everything Right

This is one of those topics where some people will see the title of the article and go, "Yeah, duh", but it will be a new perspective to others.

There's an idea floating around that effective, modern therapy should last maybe six months at most, and that if it goes longer than that something's gone wrong. If you're thinking of working with a therapist you may hear messages like:

There are also practical realities that send the message that therapy should be shorter term:

I totally understand why someone would want therapy to be quick. Mental health and life struggles are painful. No one wants to suffer for years. We'd rather spend our money and time on something other than speaking to a psychologist.

The good news is people sometimes can feel better after a half dozen sessions, maybe in only one visit. Some cases where this could apply are:

But the fact is therapy can just take longer than a few weeks or months, sometimes years longer. That's even when...

If counseling goes on for an extended period it doesn't necessarily mean the treatment has gone awry or that a scummy practitioner is milking their client. Here are some general cases where the process can take longer:

It can be frustrating to hear you may have to grapple with your problems longer than you'd like, but ultimately it's better to have a realistic idea of how things may play out. That's not to say you should always blindly stick with ongoing treatment that seems like it's spinning its wheels. It may make sense to take a break, or switch counselors or therapy methods. But everything could be going fine. It's just going to unfold at a slower pace than you initially hoped.

Here are more thoughts on some of the ideas that have come up so far:

I'm a counselor and sometimes I have a tough time accepting therapy can take longer

I just wrote that I know therapy can't always be over with quickly. However, the messages against longer-term counseling can be so strong that even I get sucked into them despite myself. Everything in my clinical training and professional and personal experience tells me that legitimate longer-term psychotherapy is a thing, but at times I still doubt myself. I wonder if I'm a failure or a fraud if I've been seeing the same client for over a year. Did I overlook some blindingly obvious solution? Am I missing a key skill? Could another counselor have fixed them up by now? Every so often there is something to my doubts and I change course as needed, but often I have to remind myself healing just takes longer for some people, despite what some sources may claim.

Just because counseling might take longer doesn't mean clients see no improvement the entire time

Even if you've got a stew of more complicated issues that may take years to fully resolve, you probably won't feel as crappy as always right until the final session. Hopefully you'll gradually feel better and better, and be more and more functional in your daily life, until one day you decide you don't need to see a therapist anymore.

Though counseling doesn't always follow a predictable, linear path. If you start digging into painful issues you've suppressed or avoided your whole life, you may feel worse for a while, while you actually deal with them. But tougher patches aside, over the long haul you should see a steady, if uneven, path of improvement.

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The idea that new, more-scientific therapies can fix everyone in just a few sessions

There are all kinds of treatments that have been portrayed as the exciting new breakthrough that can supposedly cure clients in a handful of appointments - Cognitive Behavior Therapy, Solution-Focused Brief Therapy, EMDR, Internal Family Systems, Coherence Therapy, Psychedelic Assisted Therapy, I could go on.

I'm not saying all these modalities are an over-hyped scam. In fact, there are miraculous sounding case studies for each of these methods, where clients did get relief in a session or two. Even if they can't provide an insta-cure, they can help many people after a few months of work. They've introduced valuable new concepts or techniques into the field that are more efficient than previous methods.

However, every type of "official", evidence-based therapy can point to examples where a client's issues cleared up quickly. You can say the same about alternative, less-scientifically supported stuff like hypnosis or energy healing (not that that means every type of treatment is equally as useful). The fact is everyone is different, in what they're dealing with and what will help them. There are many types of therapy, and with the right client most can show speedy results.

On the other side of the coin, each type of trendy, fast-acting modality also has clients who just have to do it for longer, if they don't bounce off it entirely. A few examples:

Just because a therapy method has some studies supporting its effectiveness as a short-term treatment, that doesn't mean it quickly works for every last person either. Without going into too much detail, when a model has a study behind it, it usually just means that on the whole the method was shown to be somewhat more effective than an alternative condition, like no therapy at all, or generic supportive listening. However, within that overall positive result some of the individual subjects may have improved a great deal, some modestly, and some not at all.

Also, research studies can be designed in ways that don't reflect the messiness of real life, and limit the conclusions you can draw from them. Like they may only use subjects that have a single, simple diagnosis. In reality most people with that diagnosis have other ones as well, which would complicate treatment. That's not to say every hyped-up therapy method with a promising study behind it is a worthless con job at the center of some grand conspiracy. It's just that it's not as simple as saying, "There's a journal article saying Therapy X treats Issue Y in four sessions, therefore if you don't get that outcome something fishy is going on."

You can hear more from people who did long-term therapy and found it ineffective than the other way around

Like a dissatisfied former client may say:

This absolutely can happen. Sometimes a certain type of long-term approach or particular therapist wasn't the right fit for a client. But there are also stories that go the other way:

Of course, it's not all or nothing. Maybe the client who initially wrote off CBT could come back to it later once they're in a better position to apply that method.

Some people who have stories of short-term therapy being effective may do something longer-term down the road

Sometimes earlier in their life someone will briefly get therapy, it will seem to be all they need, and they'll sing the praises of short-term counseling. Later in life other issues crop up, or they realize they didn't fully address the original ones, and they'll decide to do some longer term work. For example, in university a student may see a therapist because they're nervous about their exams, and feel better after two sessions of venting about the stress they're under and practicing some basic relaxation techniques. Two decades later their anxiety comes back in a big way, but this time they realize a supportive ear and some deep breathing won't be enough. Their lifetime habit of holding themselves to unrealistic standards, due to a slew of childhood baggage, has caught up to them, and will take more time to dismantle.

That's not to say everyone who initially does a brief course of therapy will eventually come crawling back and admit they were wrong. It's just that sometimes people can initially see a therapist for a short time, feel that's enough, and be vocal about it, not realizing in the future they will benefit from seeing someone for a while.

The idea that longer-term therapists are scam artists or obsolete quacks

I'm not naive. I realize drawn out counseling doesn't always have a wholesome explanation. A counselor may know their client isn't benefiting from their sessions, but the person doesn't seem to mind coming, so they keep taking their money rather than referring them elsewhere. Another, older, therapist may be in a comfortable rut, practicing methods they learned decades ago, closed off to new clinical angles that could help them do their job faster.

However, most therapists are honest. They know it's against their code of ethics to keep taking someone's money when they're sure they aren't helping. They put their clients' interests first and refer them to a better suited colleague if they decide they aren't making enough of a difference.

Though a counselor may think their longer-term approach is beneficial, and just doesn't know any better. A good therapist will check in with their clients every so often to make sure they're still being useful. And as a client it also makes sense to consider if you want to shake things up every now and then.

Some types of therapy aren't fashionable or mainstream, and may widely be regarded as outdated and inefficient. However, supporters of these modalities will say their methods are misunderstood. They can point to success stories. They'll explain how their techniques and theories have evolved, and anyone who calls them obsolete is probably referring to a dusty old strawman version of their model.

There are also clients who are just content to let counseling go on for longer, even though they could be done faster if they wanted to

They're not the main focus of this article, but it's worth quickly pointing out. Some clients are content to take their time in therapy and not do a ton of work on their problems in between sessions. They might not have a single issue they want to resolve, and just like having someone supportive to talk to every week or two, about whatever has been bothering them or is on their mind lately. They could be more financially comfortable or have good employee benefits and be able to afford to meander along. They may truly be navel gazers, which isn't always a bad thing, and want to take the time to explore and optimize their minds, without any time pressure or agenda.

To recap, if you've got something you want to work on in therapy, hopefully it won't take years and years to clear up. There's a decent chance it won't. However, sometimes that's just how it shakes out, and it doesn't necessarily mean something's gone wrong. No one's thrilled about it, but some of us just have more complex inner struggles that take a lot of time to unpack.

Related: Factors That Can Affect How Long Psychotherapy Takes