What's the ideal length of therapy from a client's perspective?

June 8, 2023 1:05 PM

I'm a therapist. My clients that I've seen longest, I've seen for about a year and a half. I love those therapeutic relationships and occasionally daydream of having a practice that is mostly people I've had for years, and then I think: wait, what? Is a year a long time? Is therapy supposed to do something more efficiently than that? I know there's not one answer here but it feels helpful to me right now to hear a bit more about how people think about this in a general, not very rigorous way.

While certainly not disinviting fellow shrinks to chime in, what I'm looking for is the perspective of people who use therapy: when you have started working with someone, what was your hope/expectation in terms of how long you'd talk with them? To maybe make more sense of the answers I (hopefully) get, were you there for a general "figure out my life" thing or a more symptom-focused treatment?

posted by less-of-course to Grab Bag (28 answers total)

I've always used therapy tactically -- am I stressed about something and does talking about something make me feel better and better equipped? Because of that, I've never had more than 10 sessions (~3 times a month) with a therapist. So maybe for me, 3-6 months?
posted by sandmanwv at 1:15 PM on June 8, 2023 [1 favorite]

I have been in therapy a few times in my life, always in crisis and looking for a safe place to process that crisis. That’s taken anywhere from three sessions to a year or so and then I no longer felt the need for therapy. Each time I went in with no specific expectations of how long the process might take, and I think each process took about as long as it needed to at the time.

My partner, in contrast, has been in therapy for most of his adult life. He has a condition for which having someone monitoring his stability is pretty essential and it’s best for both of us that it not be only me. Currently he is on a therapy break and that might be for months or even a few years, based on past experiences, but I expect he’ll go back eventually. Changing therapists is really disruptive for him and having one therapist he worked well with and could keep for years has been the mostly-elusive dream.
posted by Stacey at 1:17 PM on June 8, 2023 [1 favorite]

I have had therapeutic relationships that have lasted 8 years and 4 years. That latter one ended because they left the profession. I was bereft. I selected my current therapist in anticipation that we would work together for at least a year.

In early days I accessed therapy to treat depression and anxiety. I built a strong toolkit and no longer experience depression or chronic anxiety. Now I value the outside perspective and safe space for processing - the support and accountability are tremendously valuable for me.
posted by Juniper Toast at 1:25 PM on June 8, 2023 [2 favorites]

I first did 8 sessions once a week in 2019, focused on figuring out my life priorities, and then digging into my relationship with my parents. It was life changing for me in adjusting my thinking patterns.

Last spring I had severe anxiety/depression in pregnancy and returned to my original therapist after the perinatal one I tried wasn't helping. We did once a week for the first six weeks of intense emotion and then monthly checkins for the remaining five months until I delivered (and he was ready to resume as intensely as needed if I developed postpartum emotional disorders).

We reconnected two months ago as I was processing anxiety related to whether to stay home/return to work and a home search, plus wanting to discuss a few behavioral tendencies from my childhood so that my daughter doesn't inherit or witness those, as I want her to be strong and secure. We've been meeting every other week and I'm feeling close to finished (for now). I've been very fortunate to connect so well with my therapist and to be able to return as needed.
posted by icaicaer at 1:45 PM on June 8, 2023 [1 favorite]

I used to do strategic therapy to address big disruptions, but then Covid. Lost my income, the investment I made in a brand new business, and my housing, moved across country to accept a generous offer of a place to stay. Am going on year 3 with the same counselor, and it’s be critical to have the same person with me as I’ve tooth and clawed my way toward the goals of security, stability, and connection to people.
posted by Silvery Fish at 1:46 PM on June 8, 2023 [2 favorites]

I've had two different therapists in my life, both of whom I saw for just about that amount of time, give or take a few months. I am fortunate enough to not have any major long-term/chronic mental health issues - both times it was to deal with something pressing in my life, and when we'd really gotten through that, it started to feel like I was spinning my wheels. I didn't necessarily intend either of those relationships to be just for a year or two, but it did work out that way.

Both times I did wind up feeling a bit frustrated with my therapist at the end that it felt like we weren't really getting anywhere, and honestly, I think with both therapists I started seeing things about their style that I didn't gel with once we'd gotten through the thing I came to them about. But also, I think both times I was kind of done with therapy now that I didn't have a pressing need anymore. Especially since one of them didn't take insurance so I was paying out-of-pocket!

The friends I know who have long-term therapists either have persistent, serious mental health issues or see therapists that work in a long-term modality. Or both.
posted by lunasol at 1:48 PM on June 8, 2023 [2 favorites]

I mean, the fact is I'm a relatively succesful mid-career professional with a master's degree in a moderately HCOL area and the cost of full-time therapy (two to three sessions a month, roughly, maybe more if there's something I really need to get a handle on) falls somewhere a bit shy of 200% of my food budget and 35-45% of what I pay for housing, and it's entirely out of pocket. And it absolutely eclipses what I spend on hobbies and other discretionary purchases.

I feel like I make way too much to ask for a sliding scale rate, and while I could probably find a cheaper therapist if I really applied myself (or limited myself to situations where I could use my insurance, but that's a whole other can of worms), it's not a situation that's exactly conducive to shopping around--it can take months and hundreds of dollars to figure out if a particular therapist and modality is even going to work for me. Which is to say, it's a huge expense, and while it's undeniably useful, I couldn't imagine doing it full time for years (let alone decades) at a stretch unless I were to win the lottery or otherwise become independently wealthy. It's just too expensive and in a lot of ways feels like a luxury good, both in the colloquial and economic senses of that phrase. Is therapy twice as valuable as eating? Is it a bit less than half as valuable as having a roof over my head?

Which is to say: Yes, this is probably possible, but please think hard about the implications it would have for the population you're serving. Short-term therapy is all that's in reach of the vast majority of folks for whom therapy is in reach at all.
posted by pullayup at 1:52 PM on June 8, 2023 [16 favorites]

I did therapy once after a long-term relationship ended. I went for a year, but I felt much better after about about six months — but I got a lot out of it and wanted to keep going. I didn't have a sense of how long the process would take at all when I started.
posted by Lescha at 1:56 PM on June 8, 2023 [1 favorite]

I've worked with several therapists in the past 40 years. [Grew up in a fundamentalist Christian family that I was estranged from for most of my 20s after coming out at 21 along with a bunch of other issues.]

I'd guess that I work with one therapist for 3 months to 3-4 years. Some of that depends on the therapist and our connection. More it depends on where I am in my life. I feel like I get to a point where I'm "plateaued" and not really wanting to work on myself any more. I've always paid out of pocket, and I've been fortunate enough to afford as much therapy as I wanted.
posted by elmay at 2:03 PM on June 8, 2023

I've been in therapy three times in my life. One was treatment for a specific presenting concern, and the therapist suggested ending treatment once that presenting concern became sub-clinical. (Around four or five sessions, every couple of weeks.) The other two were both because I was so dissatisfied with a specific aspect of my life (the same aspect, incidentally, although 20 years apart) that it impaired other aspects of my life. The first time, I stopped after two sessions. My therapist, who was incredible, gave me some coping skills that worked pretty well and basically gave me permission to make a change I wasn't letting myself make, and so I didn't really need to continue. The second time, I'm been going every other week for coming on three years now. I actually have a session about an hour from now. This time, the situation isn't as easy to change, so our sessions have changed from more problem-solving and coping skills to just kind of providing an outlet for me to chat. If you wanted to be mean, you could probably say I'm buying a friend, but a) part of my problem is that I don't have a lot of friends I can talk to at the moment, and b) I have a lot I'd like to talk about. I've got an HSA; I might as well use it, right?
posted by kevinbelt at 2:04 PM on June 8, 2023

I wouldn't enter therapy with a counselor who expected it to go long term. I go when I need help with specific situations and I expect to be able to get that help in ~4 sessions. 6 max.

That said, every so often I need help again, and of course I call the same guy because he's excellent and we have a relationship; I expect that relationship to last, with infrequent renewals, as long as his practice does. My kid has one too, and every so often she schedules a drop in hour or two when she feels she needs it. My spouse's therapist, whom he used for years in the same "when stuff comes up" way, retired and it has been an unfortunate loss for us.
posted by fingersandtoes at 2:05 PM on June 8, 2023 [1 favorite]

I've been seeing my therapist off and on since August 2018. Sometimes I have to go frequently, sometimes I don't. She helps me work through things, process them and just get unstuck when I do go in. Support and accountability to help me help myself are my primary gains now.
posted by OnTheLastCastle at 2:14 PM on June 8, 2023

I did therapy for 5 years, because I had complex issues to work out. I actually would have pursued it a bit longer (after my daughter died) but first I moved and then when I moved back, I had a baby pretty quickly and it got hard to schedule.

The long timeframe was really based in a few things for me. One is that it takes me at least a year to trust anyone enough to both share and listen, or at least it did at that time. The second was that was I was processing took a few turns around the wheel to do it - the first time might just be being able to get the words out, the second might be talking about it with some emotions attached, the third might be its impact on a current situation/set of behaviours, the fourth might be even more emotions. When you add a fragmented childhood onto that, there's just a lot of...iteration.

That said, my therapist always made space for me to do a check on whether things were progressing or stagnating.

In terms of progress, I would say for me at first it was slow, little progress, but at some point it really snowballed into being - more human. Prior to that my experience was more a bundle of bad feelings wrapped in a bunch of roles. I really can't say what it would have been like if I'd started with more ground under me. But the hallmark of the therapy was - even though it sometimes made me feel terrible, it never took ground away from me. It built it under me. At a certain point there was enough to stand on my own (which I didn't realize until more bad things happened w/out therapy.)

I spent the equivalent of a downpayment on a Toronto house (2003 prices) but it was worth every penny and probably more. However, it meant not travelling, not renovating, not eating out a whole lot, etc. (and that was at a different economic time, from a privileged situation with my spouse's full support and my own full time job as well.) So there really is that aspect too.

I think the most important thing is to keep your clients' needs in mind. People won't need more, or they will need to make do with what they have. I guess one thing I trusted my therapist to do was not let me stagnate during those sessions. If I'd thought she had a goal of only collecting long-term clients I think I wouldn't have trusted her with the rest.
posted by warriorqueen at 2:23 PM on June 8, 2023 [2 favorites]

As a patient I felt like 2 years was a good amount of time. In my own circles it seems like patients who have been in therapy on the order of decades was ... not uncommon, especially with more seasoned clinicians in their 50s-70s.
posted by gemutlichkeit at 2:28 PM on June 8, 2023

I’ve been seeing my same therapist for 15 years or so. Sometimes I see him more. Sometimes I see him less.
posted by creiszhanson at 2:46 PM on June 8, 2023

I started therapy when I had some anxiety that was negatively impacting my life. I pay out of pocket for the most part (insurance covers like three visits a year which is sort of worse than nothing in some ways). I've been through three therapists in the past six or eight years and only switched because the other two retired. Like many others, sometimes I go more often (when I bought my house and moved I went weekly) and sometimes less often (I usually go maybe monthly). I find that it really helps me to have someone to regularly bounce things off of. I have a really good set of friends and family in my life but I don't always feel comfortable going on and on about some of the stuff that is on my mind and keeping me from being able to live my life the way I want to. I am fine having a long-term relationship with a therapist.
posted by jessamyn at 3:25 PM on June 8, 2023 [2 favorites]

Hey, so, I've been in therapy off and on since I was 12 years old. My current therapist I've seen (off and on) since 2011. I have recurrent depressive episodes and he's pretty good for helping me sort of work my way through it. I stopped going in about 2014 and then kind of started back up again a couple years ago. It's nice to a have a long relationship with someone who knows you. It makes it easier to get back into it without all the introductions.

Jessamyn put this more succinctly than I could. It is indeed very helpful to have a someone to regularly bounce things off of when you need it. Admittedly, I can only do this because I can afford to pay (sliding scale) out of pocket, because my insurance will not cover my therapist.
posted by thivaia at 3:57 PM on June 8, 2023

Depends on the issue(s) I'd be going for.

Generally, if for a more targeted issue or set of issues, 2-3x a month for 4-8 months.

If a wider and broader range of issues, in the altogether pretty neurotic end of the spectrum, maybe up to a few years.

If it's just kind of life-insight and actualization therapy- such as Jungian- which, incidentally, few people have the money and liberty to afford- maybe occasional sessions for a few or several years, waxing and waning, maybe resuming again down the road.

I've come to believe that, even though it's nice to have long relationships with some patients, generally therapy should be somewhat effective for targeted purposes within a certain range of time.

Not a believer in the 'lifelong Woody Allen' school :-)
posted by cotesdurhone at 4:49 PM on June 8, 2023 [1 favorite]

I saw one therapist on and off for a period spanning 30 years. We got too comfortable near the end and I wanted a different modality. I have been seeing my current therapist for about 4 or 5 years, during which I have been dealing (quite well) with some major life stage changes.
posted by matildaben at 9:48 PM on June 8, 2023

I live in the UK where free therapy is available on the NHS but is very nearly always limited in duration and you get no choice of therapist. 12 to 16 weeks is typical. I've been referred for NHS therapy several times in the past, usually for treating depression (I actually have a history of psychosis and my diagnosis is bipolar disorder but they use a "stepped care" model here that tends to leave people with severe diagnoses struggling to access the most appropriate treatment).

Although the therapists I worked with were good, each time both I and they were frustrated that 16 weeks was insufficient for lasting change. My moods could cycle over that period anyway so it was hard to disentangle any benefit from a temporary upswing. While that seems like it would be a particular problem with bipolar I have noticed a similar, less exaggerated pattern among friends who access therapy with mild/moderate depression and anxiety; natural fluctuations in mood can make short term therapy look more effective than it is, only for the problem to resurface months afterwards.

I took what I was given because it was free and I couldn't afford to pay. I am not, actually, convinced it was better than nothing in my case, though I understand for other people it really may be.

My work circumstances changed a few years ago and I was able to afford private therapy as a result. At the time I was coming off anti psychotics and I wanted therapy to maintain my stability (and to catch any early warning signs that I was deteriorating). Neither of us thought the therapy would go on indefinitely but I didn't know how long I would need it and wanted it to be open ended. I would say it took six months for me to establish a really good relationship with the therapist. The issue that was causing me most problems blew up about eighteen months in. I also developed some physical health issues that the therapy helped me with because that relationship was already up and running. I've now been going once a week for three and a half years.

I still don't expect to be going forever - and I can't afford to go forever, but I've never once doubted the value of what I'm paying for. I'm doing better than I ever did as a result of short term therapy.
posted by Ballad of Peckham Rye at 11:26 PM on June 8, 2023 [1 favorite]

I suggest that your clientele may have no idea, or maybe the wrong idea, about the role time plays in the work you guide them through. Instead, can you put forward a few clear statements abotu what to expect from certain periods of time? Like, are there things that can start to help in 2-3 sessions? 8-10 sessions? Are there expectations and goals that are flexible, open-ended, possibly long-term processes rather than deadline-able achievements to aim for? Is there a difference in therapeutic impact if sessions are weekly, bimonthly, etc.?
posted by late afternoon dreaming hotel at 2:45 AM on June 9, 2023 [3 favorites]

Depends on what people struggle with and what kind of therapy they need. Someone with trauma or other kinds of deeply rooted struggles will need a lot of time. (People who need this usually can’t access it - or have to go to great lengths to afford it, as warriorqueen did - unless you’re working through a hospital with exceptional funding sources.) Someone with an adjustment problem, much less.

The evidence based modalities I’m aware of people often needing are CBT, DBT, ACT, EMDR, MBT or more psychoanalytic approaches, all of which have a clear rationale and purpose. Not meaning to be challenging, but outside of financial concerns - which are obviously considerable for most people - duration of therapy alone is not the key factor behind a treatment approach, usually. Do you feel comfortable with the toolkit you have? Maybe some more specific training would help?

Ok, from personal experience, I once had a really well structured experience with someone approaching therapy from a humanistic perspective. (Disliked the communication style of the therapist so that was too bad. But I appreciated how it was set up.)

The framework was 12 sessions. Session 1 and 2 were about going over protocols and, crucially, defining goals. I was asked what I wanted help with, and what I could imagine meeting those needs looked like, in super practical terms. Wrote it down. Session 6, we had a meta discussion - how are we doing in this? Are we getting where we need to be? Does anything need to be tweaked? Reviewed goals and approach. The idea would have been to carry on to the 12th session.

I didn’t get to 12, because the main issue I was having with the therapist was she was wanting me to be hyper excruciatingly expositive about things I felt I was being *relatively* clear about. Just couldn’t get into a communicative groove. Wasn’t expecting mind-reading, and it’s possible I wasn’t always as articulate as I’d imagined, but I felt like I was talking to a picky, super literal coworker who was bent on not understanding. That is also a technique in itself but man, did I need the discussion about my troubled emotional state to be as grinding as my troubled emotional state? I decided no. Regardless, having metrics and check-ins are a good idea.
posted by cotton dress sock at 3:23 AM on June 9, 2023 [1 favorite]

1st time - about 18 months. I was in therapy for symptoms (anxiety) but the root causes of my anxiety went very deep and required a lot of unpacking beliefs I'd internalized and where they came from in my life story. I had to end therapy because I switched insurance providers. I would have continued longer if that hadn't been the case.

2nd time - about 6 months. I was in therapy to develop a "toolkit" to handle specific types of situations. I didn't plan for it to be 6 months and would have been fine with this being ongoing, but around the 6 month mark was where I realized I didn't really have any questions to ask my therapist and felt like I was just trying to fill time in our sessions. This therapist was great and I would see her again if I needed treatment again.

I think I would be a little uncomfortable if my therapists said they "loved the therapeutic relationship" they had with me. That's the piece of this I'd zero in on.
posted by capricorn at 5:31 AM on June 9, 2023 [1 favorite]

can I ask what you mean by "loving the therapeutic relationship" you've had with clients who are in your care for a year and a half at a stretch? Because to me that sounds like you're enjoying the power differential of having someone need you for this long; and/or enjoying the consistent income; or enjoying the pain of seriously troubled clients. But maybe you meant something else?
posted by fingersandtoes at 7:29 AM on June 9, 2023

I can speak to “loving the therapeutic relationship” from the client side. I worked with a therapist weekly for five years, until she retired. She used a psychodynamic approach, which worked really well for me, so we talked a lot about our relationship and my thoughts and feelings about her.

I started therapy this time because of depression, but I had a lot of ongoing stress and challenges with family, work, pandemic, etc. so we always had lots of material to work with. She helped me do some really powerful work with anger, with core beliefs around my unworthiness and drive to please.

I loved her, and I believe she loved me. She had great boundaries so the relationship was always completely appropriate, but it was also warm, real, full of laughter and insight and the space to express hurt and make repairs. We did amazing creative work together, taking whatever I brought in each week and making something beautiful and moving from it. I almost always cried, and working with her helped me get comfortable and knowledgeable about my feelings in a deep, lasting way. I believe she enjoyed hearing my stories and watching the way my mind worked.

I would have gone on seeing her forever if I could. When she told me she would be retiring in a year, I burst into tears, and we were able to do some powerful work on grief and loss as we processed that.

I considered her a friend, a creative collaborator, and a skilled professional. I never felt taken advantage of. For a long stretch she charged me half-rates when I couldn’t afford full fees. I always felt free to end or cut back therapy, and I never felt she pathologized me or wanted to keep me “dependent”.

I’ve had a few therapists since. I don’t think I’ll ever have another one like her. I miss her often.

I recently recognized that I have ADHD and autism. I can see that many of my challenges derive from my neurodivergence, trying to cope in an allistic world, and how religious trauma and codependency interacted with that. I suspect that neurodivergence played a role in why weekly therapy was so valuable to me and also why it was so satisfying to identify patterns and articulate my experiences.

I understand the desire to work with clients in this way, and I expect that neurodivergent clients would be well suited to developing this kind of close, long-term therapeutic relationship.
posted by alicat at 8:06 AM on June 9, 2023 [6 favorites]

A couple short term stints on the order of months and a couple long term ones on the order of multiple years. The short term ones were with students at my university. The long term ones were with local psychologists. I was working through severe trauma issues. It takes me a loooooong time to trust people and I will shut down if something feels threatening. I had that happen with my current therapist so I took a break. I'm down to monthly checkins with her and as long as my insurance is cool with it, I'll do that. I journal and use that in my monthly checks.
posted by kathrynm at 3:42 PM on June 9, 2023

I've been seeing my current therapist for the better part of 7 years. However, my cadence is not super frequent - usually once every 3-4 weeks, occasionally more often if I want it. I still feel like I'm benefitting from the experience and the relationship, and while I've occasionally considered ceasing therapy due to nothing specific to work on, I still find talking through things helpful, and the cost at this frequency is manageable.
posted by rachaelfaith at 5:50 PM on June 9, 2023

I’ve been in therapy on and off for more than 20 years. Each time I’ve gone I’ve gone for about a year.

Personally, I find symptom-focused therapy really frustrating and transactional. I’m looking to discover and heal the underlying reasons why.
posted by sevensnowflakes at 8:54 PM on June 9, 2023 [1 favorite]