Factors That Can Affect How Long Psychotherapy Takes
It's hard to say how long therapy will take for any one person. Two people could have the same outer symptoms, but have different things going on under the surface and in the rest of their lives. One may be able to feel better fairly quickly, while the other may be in treatment for the long haul.
When therapists speak to potential new clients they're often asked, "How many sessions do you think it will take to help me?" They often give a vague answer like, "It's different for everyone." It's not that they're purposely trying to be evasive and unhelpful. They'd love it if they could give a precise number. It's just tricky to know for sure, and they may not want to make a bad, overly optimistic guess and set someone up for disappointment.
They may say something like, "Well, about half of the clients I see with your issues feel noticeably better in three months." That may be true, but that statement also implies the other half are with them for longer, and it could be for much more than a few months.
If they practice a more structured type of therapy they might say, "For social anxiety I do a twelve-week program. Some clients find this is all they need, but when we're done we can decide whether additional sessions are appropriate." Again, some clients may be good to go after a dozen weeks, but others may have to be involved for longer.
It's just tough to know for sure. Here's a long list of factors that can impact how long counseling takes. I did my best to separate them out, but many can tie together. If you're thinking of going to therapy it may give you a very loose sense of how long it may take, but that's all. I wrote this article more to share my thoughts on the different variables.
I want to make it clear that none of these factors are meant to be read as disparaging or blaming to any clients who have them. They're very common, human issues that we all deal with. It's hard to change, and no one is purposely being weak, broken, or difficult if something gets in the way of that.
How severe your symptoms are
No shock here. Therapy will usually take longer if the problems you're struggling with are more intense. Debilitating trauma symptoms from a horrendous childhood will obviously take longer to treat than some mild, situational anxiety related to switching jobs.
There are exceptions. For one, every so often severe symptoms can be resolved fairly quickly with the right type of therapy. For example, someone might be debilitated by PTSD, but feel mostly better after a handful of sessions with a method that finally helps them process the original traumatic experience. Sometimes serious depression quickly resolves after an unconscious motivation for sustaining it is unearthed and dealt with. It's usually not this easy. I don't want to get anyone's hopes up. It can happen though.
On the other hand, sometimes seemingly minor, niggling issues have a complex web of old baggage and unconscious conflicts underneath them, and it can take years to sort everything out. For example, a client may be slightly grouchy and temperamental. It's not intolerable. It hasn't ruined their life. They've already gotten a lot better by doing things like exercising and reading self-help books on increasing self-control. But there's a mysterious, stubborn core to it that doesn't seem to shift. It'll take a lot of digging to get to the bottom of.
How treatable your issues are, in theory
Some symptoms or mental health diagnoses are known to be relatively quick to treat. Others are a longer-term undertaking. PTSD from a sudden trauma, like a bad car accident, can sometimes be treated in a few sessions. Some phobias can be eliminated after a few months of Exposure Therapy. Chronic anxiety, low self-esteem, and trust issues all resulting from childhood abuse may take years to heal.
Again, this is all a rough guideline. As I said, sometimes straightforward or mild issues have a lot going on under the hood, and don't get better according to the best-case scenario timeline. Sometimes clients will show up to therapy with seemingly serious concerns, but after having someone to talk to for a few sessions, they feel a lot better and are happy to stop for now. They may not have cleared up everything and will be back later on, but they're good to go for the moment.
How many issues you want to work on
No surprise, therapy will go faster if you only have a single, isolated problem you want help with vs. ten different things. Odds are if someone has ten issues they're going to be interconnected, but even if they could be cleanly separated, it will just take longer to address each of them one after the other.
If you have several issues you want to address, how much you switch between them session to session
Even if you have a bunch of things you want to work on, you could still ask, "How long will it take to deal with each of them?" If it were possible to give an accurate answer, it's generally going to be quicker if the client can focus on one problem until it's resolved, then move onto the next one, as opposed to jumping around between them.
Of course, it's often easier said than done to stick with one problem and put everything else on the shelf. The issues may be tied into each other. Sometimes it makes sense to put one topic on hold to focus on another area that's influencing it. Maybe a client wants to figure out whether to quit their job. That's simple enough at first glance. Though it could turn out their depression and insecurities are paralyzing their ability to make a decision, and things won't move forward until those deeper problems are addressed.
Also, many clients don't care about preceding with maximum, soulless efficiency. If they've got five things they're working on, they want to talk about whatever is on their mind or bothering them the most that week. It may be the best move on paper to focus on their fear of public speaking until that's better, but if they got into a big fight with their boyfriend last night they're going to be fine putting their presentation skills progress on the backburner.
How consciously motivated you are
If two people have the same problem, but one is motivated to attend every therapy session, and actively works on their issues between appointments, they're going to improve faster than someone who's on the fence, skips half their sessions, and doesn't want to do any work aside from talking to their therapist for an hour every so often.
There's no shame if you don't approach therapy with inexhaustible enthusiasm. It's fairly common for clients to want to feel better, and be willing to attend regular sessions, but at the same time they've got busy lives and aren't open to doing a ton of other stuff in their spare time (e.g., starting a meditation practice, going out and facing their fears four evenings a week). And they're fine with that meaning they won't change as fast as possible.
How motivated you are on an unconscious level
Sometimes clients feel very consciously motivated, but still can't seem to move forward. If they're not blatantly sabotaging themselves, they're just spinning their wheels for years. That's because while a conscious part of them may dislike an issue, an unconscious facet of their mind may think it's helpful and necessary, even if it has downsides. For example, someone may hate how sad and unmotivated their depression makes them feel, but on an unconscious level they're terrified of success and change. Being depressed keeps them where they are, and if it makes them feel tearful and lethargic, that's an unpleasant but worthwhile price to pay.
Of course, you can't know ahead of time how much unconscious resistance is holding you back, but once you start therapy you can often get a sense of whether it may be involved. You may feel like you want to resolve your problems, and not be able to identify any reasons against changing, but then strangely not follow through on any of your counselor's suggestions for months on end.
How much time you have to work on your issues outside of sessions
Not every therapy method assigns lots of between-session homework, but even if it doesn't there are often useful things it would make sense to do. For example, going out to meet new friends, or practicing emotion regulation techniques. You're going to make faster progress if you have time to do these tasks, as opposed to being super busy.
You could argue that if someone was truly motivated they'd make time for the practices that will heal them, but again, I'm realistic. If someone works long hours, then comes home to take care of their kids, they may technically have half an hour before bed to meditate, but they just want to veg out. For all intents and purposes they don't have the time.
How content you are to take your time working on your issues
This is often connected to motivation levels, but not always. Some clients are in a rush to fix their problems, which is very understandable. They want to get as much as they can out of each session. They often want to use the days or weeks in between visits productively too.
Others have less sense of urgency. Even if they're motivated to change, they're happy to go at a slower pace. They're alright with spending some sessions discussing topics unrelated to their primary concern. They may be okay with scheduling an appointment once a month instead of every week. They may make positive lifestyle changes on their own time, but again, not at breakneck speed.
Whether your life is fairly stable or full of unpredictable crises
Ideally as someone goes through therapy the rest of their life stays steady and uneventful. Not everyone has it so good. Their circumstances are unstable, and things often pop up that derail their focus. They may work in an uncertain field and have to find new work every few months, or have abusive, unpredictable family members that come in and out of their lives. Of course, when one of these complications comes up they may have to put their original therapy goals on hold, so they can douse the immediate fire.
Sometimes this factor is discussed in a client-blaming way, as if certain people purposely invite a lot of chaos and drama in their lives, so they can distract themselves from making any real changes. Sure, there can be aspects of someone's mind that causes them to make iffy decisions which lead to their lives being tumultuous, but they're not deliberately trying to be difficult. They're doing the best they can with the tools they have.
Your practical ability to attend regular sessions
Therapy will take longer if you can only attend sporadically. Some clients are easily able to see their therapist every week or two. Others have various barriers that prevent that. They may not have enough money or consistent insurance coverage, their schedule may change at the drop of a hat, they may have unpredictable health problems or demanding jobs that make them have to cancel at the last second, and so on.
Your personal standard for when you'll feel done
Let's say someone struggles with worry and insecurities, and it's having a negative effect on their job performance. They may feel satisfied with therapy when they're able to function at work like they used to. They might still have some lingering nerves and self-doubt, but if it doesn't outwardly impact their career, they can live with it. They can accept an ongoing 3/10 version of their issues.
Someone else may want to go the extra mile and eliminate their tendency to worry at the root. They don't unrealistically want to never be anxious again - that's impossible - but they're tired of excessively fretting about the future. That's a higher standard, and will take longer to achieve.
Your existing knowledge and skills about managing your issues
Some clients come into therapy with no knowledge or skills for dealing with their problems. Like someone may have panic attacks and know nothing about the psychology behind them or the principles for recovering from the condition. It will take a bit longer to initially get them up to speed. Another client may have already read several books on managing panic attacks, and have a variety of tools for dealing with them. They just need some hands-on support as they implement the steps to overcome them. They can dive right in.
How much you're able to have a trusting, open, harmonious relationship with a counselor in general
Psychotherapy will go more quickly if you and your counselor can get right to work. If you have a hard time trusting, opening up to, and working peacefully with them, it will take additional sessions to sort that out. Of course, feeling anxious and distrustful around people, or having a tendency to get into conflicts, may be tied into your core issues, so working through those things with your counselor may be directly helpful.
Again, I'm not trying to shame anyone if they're not able to instantly be buddy buddy with a new therapist. If you're wary of them, it's due to events from your past that have given you good reason not to cozy up to everyone right away.
How good of a fit your therapist is for you
Therapy tends to go faster if...
- You click with your counselor - you feel comfortable around them and have good rapport
- Your therapist is more skilled and experienced
- Your therapist is knowledgeable about how to treat your particular issues
A well-matched therapist can't magically do everything for you, but you'll get more out of each session. At times what makes someone a good match isn't what makes sense on paper. You may first see a veteran clinician who's an expert on your condition, but their style and methods just don't help much. Then you start working with a nervous intern who's making it up as they go, and they somehow manage to say everything you need to hear. Sometimes you'll really like your counselor as a person, but the sessions feel like two friends catching up and not much changes symptoms-wise. Then you switch to someone where the relationship feels more strained and formal, but you buckle down and get a lot done each week.
The type of therapy you're doing, and whether it's a good match for your issues
There are many different types of therapy, and there's ongoing debate about which ones are best suited for which problems. Proponents of various established schools will claim theirs is best, but you'll also get counselors saying their less-fashionable modality is actually just as good, but just hasn't had the time to build up a scientific evidence base or worm its way into the public consciousness. Similarly some types of therapy claim to be faster and more efficient. They'll portray other methods as being hopelessly slow and stuck in the past.
In some cases we know certain approaches are better. Like if you have PTSD from a simple trauma, you can often quickly resolve it with a good trauma processing method. You wouldn't want to spend years analyzing the unconscious conflicts behind it. That may help a bit, or pay off eventually, but it's not the most direct route to the goal.
But again, it really comes down to your particular issues and what's going on with them under the surface. It may seem like they're suited for a quick, efficient method, but once you try it you may get lackluster results. A seemingly glacial, stodgy method may ultimately be what solves your problems the quickest, even if it still takes years.
A variety of mental factors that impact how much you're able to absorb and benefit from counseling
Some people have mental traits that help them get more out of therapy and benefit from it faster. Once more, it doesn't mean someone is broken or flawed if they're not the ideal pupil. They can still be helped by counseling, but it might take longer. And if it takes more time it's not necessarily because they're cursed to always be slower to grasp anything. It may be that they can make fast progress with a therapy method and style that fits how their mind works. The only slowdown may be taking extra time to find and dial in an approach that works. For example, a therapist may be used to explaining concepts with complex visual metaphors, which their client doesn't understand easily, but everything starts going fine once they switch to more straightforward language.
Some of these factors are:
- Overall intelligence - Yeah, intelligence isn't always a blessing. Sometimes very intelligent clients are extra good at rationalizing their self-limiting behaviors or can waste time trying to overthink things. But on the whole less-intelligent clients may take longer to absorb certain concepts and put them into practice.
- Learning disabilities - That is, difficulties in learning in certain ways, even though one's general intelligence is average or better. It may take more time to land on a teaching or explanation style that works for them.
- Abstract reasoning - I.e., the ability to grasp concepts such as "Trying to force yourself not to have a certain thought can paradoxically make it worse."
- Executive functioning - I.e., higher level abilities to plan, organize your time, focus your attention, and so on. Someone with issues in this area may struggle to, say, put therapy suggestions into practice and fit them into their schedule.
- Psychological mindedness - How good someone is at being introspective, reflecting on their thoughts, motivations, and behaviors, and drawing insights from them. Some people are naturally good at tuning into their thoughts and how they're driven by them. For others it's much more foriegn.
- Long and short-term memory - Someone with memory issues may struggle to retain information learned in counseling, either minutes after hearing it or in the weeks to follow.
- Attention span - Can someone focus and take in everything that's happening in a session, or does their mind wander if, say, the therapist talks for too long or there are too many distracting things in the room?
- Ability to visualize - Some people easily form images in their minds, while others struggle with it or can't do it at all. This comes into play if the therapist uses exercises that ask the client to picture various situations, like imaging comforting their neglected child self.