How long does therapy take? That’s an interesting question. Logically, people seeking therapy want to have some idea of the time, energy and money they’ll be required to invest in the process. To begin to answer the question we need to deconstruct it. On the face of it, it appears simple enough, and glib short answers could be offered. But, when we ask how long does therapy take, we subsume into our question the notion: “… to work”. Then we also must engage in the discussion: “What do you mean by ‘work’?” Further, we could ask: “What form of the many, many types of therapy are you asking about?” Then we could ask: “How effective is your therapist?”; “How do you relate to your therapist?”; “How frequently will you attend sessions?”; “How committed are you?” etc

Also, a complication in answering the question as to how long therapy takes stems from the great variety of reasons people seek therapy and the wide variety of the degree of commitment people might apply to their therapy. One person might come to therapy with a single issue. Another may come with a complex interplay of issues. One person may assiduously complete their between session tasks. Another may think they will change as a result of simply attending sessions. One person may come to therapy with a long-standing, serious mental health challenge. Most actually come with time-limited contextual challenges in living. Some may become dependent on therapy. Some may be able to clearly derive therapy aims against which success can be measured. They may be able to state what skills they want to learn and be able to use. They may be able to state what they want to be doing more or less of, or start or stop doing. They may need to make space for something they can’t change. Another person may struggle to generate, specific aims. For example, if, asked what they want to get from therapy, a person replies: “I want to feel better”, then a much clearer, objective and quantifiable aim will need to be derived.

With respect to couples, I have often noted when I am introducing them to therapy that being able to predict the time it may take to achieve their aims through therapy is like asking the proverbial question: “How long is a piece of string?” I can offer average number of sessions or periods of time and outliers from both my own and the international experience of experts, but no-one can predict with any certitude how long a given person or couple may take to graduate from therapy. However, I can tell couples that couples counselling does take time – more time than most individual counselling. And, often more time than they may have imagined.

There are schools of thought that espouse “the more the better” with respect to therapy.  That might be so – in some cases. However, consider the idea that if a little of something is good, “more must be better”. Not always true. Taking one example by comparison: if a little sunshine is good, more is better. In mid-winter, on a day of 15 degrees a little sunshine would be beneficial and pleasant. Good for vitamin D. Nice and warm But, even mid-winter, too much sustained sun exposure at peak UV levels can lead to skin cancers. Switch to mid-summer, with temperatures in the high 30s and 40s. Even a “little” sunshine could have adverse effects. More would decidedly not be better.

Some critics of the “more therapy is better” school of thought have proposed that if therapy is taking an overly lengthy period then the therapy is not working – yet. That may be so. It may also be that therapy is simply not working – at all. Or, it may simply be that in a given case more therapy is necessary. Some types of challenges just need more treatment sessions than others. More chronic and more serious, long-standing challenges like psychoses or personality disorders will generally require lengthy therapy. The extent and intensity of signs and symptoms at intake; the length of time the person has experienced the challenge; resistance to previous therapy; the unsuitability of previous therapy approaches; therapist skill; and, the resources the person can muster – all these will impact the length of time therapy may take.

There is one factor that contributes to there having to be more therapy sessions. It is the “intake tradition”. By this is meant the process wherein the therapist will spend up to an entire hour and a half asking a wide range of questions but not engaging in any therapy per se. In some cases a therapist may even engage in a further session to simply complete the voluminous intake. Up to two and a half hours. Opponents of this approach acknowledge that, in some very rare cases, this process may be useful. However, it is also argued that it has simply become a mostly unquestioned tradition, applied regardless of the presentation or cost to the client.

The belief in long term therapy likely evolved from several sources. The Freudian psychoanalytic tradition espoused therapy taking years. The cognitive behaviour therapists later devised treatment regimes for a host of conditions that were developed in university psychology labs or health care facilities wherein manuals of treatment requiring on average twenty sessions. This “manualised” treatment approach has had a significant impact on the thinking of therapists since.

However, very effective short-term therapies have been developed by therapists who have questioned the idea that therapy needs to take a long time. Solution Focused Brief Therapy (the name says it all); Motivational Interviewing; and, Focused Acceptance and Commitment Therapy, for example, a three highly effective brief short-term therapies.

What do the statistics tell us about the number of attendances at therapy sessions? We know that the modal number (i.e. the most commonly occurring number) of sessions for all presentations, for all types of therapy internationally is – one. A single session. In Australia, Medicare has used statistics pointing to the average number of sessions the majority of people attend therapy in Australia doesn’t exceed six, to determine the number of sessions eligible for a rebate under a Mental Health Care Plan. Apparently the most common number of sessions Australians are funded by MBS rebate to attend therapy under a Mental Health Care Plan has been six with the option to extend by four more sessions to ten. The Covid pandemic and climate change bushfire disasters and lobbying of the government by the Australian Psychological Society increased the upper limit of rebatable sessions from ten to twenty for certain conditions. Since then there has been a push to increase the number of Mental Health Care Plan sessions from ten back to twenty – or more. That’s a lot of time out of the workplace. Those who can afford lengthy therapy in terms of time off work impacts many clients. Not to mention the financial cost of therapy.

In summary, the answer to the question: “How long does therapy take?” would seem to hinge on the type of challenge you present with; your ability to generate achievable aims in conjunction with the therapist; your engagement in between session tasks; and, the type of therapy on offer by your therapist. One answer I have heard offered to the question: “How long does therapy take?”, that appeals to my sense of logic, is: “As long as it takes for you achieve your aims of therapy – and no longer”.

© Gregg Chapman, 2021.