How much therapy do we need?

If this is your first time considering therapy, this question might have already started worrying you: how much therapy will you need? A handful of sessions? A couple of months? Or, perhaps years?

It can feel daunting to navigate between offers, from short-term to long-term therapy and the prospect of committing to something unknown for many months could bring up difficult feelings about ourselves.

While there is no easy answer to the question, there are aspects you can consider before you embark on the journey. The two most important questions to think about are:

• What do you hope to achieve?
• How long has it been since you started struggling with your problems or your symptoms?

The first question is about your expectations. Any length of therapy can be effective, provided that you feel you have achieved your goal - and that goal fits into what is realistic to reach in a certain amount of time.

The second question is a bit of a mystery: many of us don’t seem to realise how long-standing our struggles are until someone starts asking questions about it: how long have you felt this way? Is this situation or feeling familiar to you? When was the last time you have experienced something similar? Or when was the last time you felt content about yourself, your life, your future? The exploration of these questions can shed light on how big of an iceberg you are facing.

To give a crude overview, short-term counselling usually means one to six sessions, mid-term between 12 to 20 sessions and beyond that it is long-term therapy with various lengths of time, anything from a year to a decade. Some modalities of therapy offer only short or mid-term while others are usually suitable only for long-term therapy. When you consider these options, you may want to understand what you can realistically expect from talking therapy.

In terms of expectations, short-term counselling is most useful when there is a clear, well-defined focus in the work. In short-term work, this usually relates to the presenting problem: a particular issue you would like to get through. This could be an event that causes elevated stress or anxiety (a promotion or redundancy, a wedding or a difficult break-up, entering into new stages of your life) or a loss you need to manage (retiring, an empty nest, etc.).

The rule of thumb is to find the issue that is most pressing for you and work on that over the course of a couple of weeks. You and your therapist both need to agree on the focus so there is mutual engagement in working with it. The approach of your therapist will be something like all hands on deck: asking questions about the presenting problem, exploring your ways to deal with it and supporting you to get some insight into what is happening, how you can manage the process and how it might relate to you, your personality and your history.  

Ideally, you and your therapist agree on the number of sessions - you work together and have a planned ending in sight from the very beginning. Short-term therapeutic work can help you to address the issue in focus and learn about yourself and your defences in relation to that particular problem.

So, how is mid-term work any different? Well, you have more time. Focus is still important, however, we can expand the scope of our focus. The set-out is the same: you and your therapist agree on the number of sessions and the focus of the work. However, as more time is available, the focus can be a trait of yours, rather than a specific issue. For example: how you judge yourself, how you care for your own needs, how you relate to others etc. These could be specific to your situation or a broader aspect of yourself if that feels manageable.

Your therapist will help you to stay on the chosen focus but can also help you to discover deeper connections about what lies under the surface, and how that presents itself. The relationship you create with your therapist becomes a vital part of the work: through this unique therapeutic alliance, you can get to know yourself better. In this way, mid-term therapy can have lasting effects on you as a person, it can open up new dimensions of self-awareness and capacity to create more fulfilling relationships with others.

Long-term therapy is offered as open-ended work. In this case, you and your therapist work on an ongoing basis. Obviously, there will be a planned ending but it is not set from the start, it comes along as the process evolves. The difference in long-term therapy is the time: it is unlimited therefore we can follow every thread you bring up in the session to see where they take us. Some threads lead nowhere while others open up new routes - and oftentimes their importance only becomes obvious once we have followed them.

The time we have is a key element for exploration. It is a common experience with long-term counselling that the first couple of sessions are filled up with words and time flies but soon stories run out and clients find themselves wondering what to talk about. This is an important turning point - this is where the work dives into a deeper level. When there are no more big stories to tell, we can look at our inner world, thoughts and feelings in detail.

Long-term therapy is about personal development, you can work on any aspect of yours, and you not only open up a window of insight but you will see your own processes unfold week by week. Your therapist is there for you to facilitate this process and support you to see yourself from the outside and simultaneously to understand what is going on in you.

Healing and processing take time. To tie this back to the two original questions, in talking therapy the longer commitment brings longer-lasting development and reaches deeper levels of you as a person. The longer you have been struggling with the same problems, the more likely that your iceberg reaches deep down in your own sea.

As my trainer once said, if something took decades in the making, you cannot undo it in a fortnight. So when you think about the length of therapy, also consider how far you feel you would wish to go. You might find you only need relief and a little guidance, some handy ways to manage your situation. Or maybe you feel you have exhausted all you could think of and you want to look behind the curtain, really understand who you are and find your resources to choose your journey rather than collide with the same iceberg over and over again.

Whichever is your experience, remember that this is about you, so just be honest with yourself. Opening up with a stranger can feel very uncomfortable but the benefits of doing so can bring you that much-needed change.